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Full text of "United States Navy Medical News Letter Vol. 43 No. 4, 21 February 1964"

FEB 2 4 1964 



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; UNITED STAT ES NAVY \ 



"73 




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Vol. 43 



Friday, 21 February 1964 



No. 4 



TABLE OF CONTENTS 



MEDICAL ABSTRACTS 

Tropical Medicine Symposium: 
Mosquito -Borne Epidemic 

Hemorrhagic Syndromes .... 3 

Developments in Virology 5 

Scrub Typhus 8 

Rabies - Problems and Progress 9 

Chagas* Disease 

SUBMARINE MEDICINE 

Clinical Problems of Scuba 

Diving 12 

MISCELLANY 

Use of Governnnent Quarters by 

Persons on TAD . 15 

AFIP Film Loans 16 

American College of Physicians . , 16 
Officers' Wives Club Scholarships 17 
Membership in the AMA 17 

FROM THE NOTE BOOK 

Pharmacy and Materia Medica - 
Correspondence Course 18 

Praise for Job Well Done 18 

NP Clerical Technic Course and 
Class. Code HM -8444 Canceled 19 

Naval Medical Research Reports 19 



DENTAL SECTION 

Serum Proteins and Local 

Anesthetic Agents 22 

Portable Dental Sterilizing 

Cylinder 22 

Procedures Preceding the 

Prosthodontic Prescription ... 24 
Powdered Gold as Restorative 

Material 25 

Personnel and Professional 

Notes 25 

AVIATION MEDICINE 

Flight Physiology Notes: 

J . A* rvL, ..*...•••••■#..."••• ^7 

Hazards of Dusk . . : 31 

Leadership Concept - Hard 

Vs Soft Management 32 

DA NANG Doctors 33 

The Aviation Physiologist 34 

Inam^ersion Hypotherraia 36 



RESERVE SECTION 



38 



New Correspondence Course.. 
MSC CDR to be Executive 

Director of Occupational 

Therapy Association 39 

Navy Ensign 1915 Medical 

Program (Continued) 39 

MA0I6AN GENERAL HOSPiTAL 
MEDiCAL L!B:^AR'/ 
OFERTY OF U. S. ARMY 



United States Navy 
MEDICAL NEWS LETTER 



Vol- 43 Friday, 21 February 1964 No. 4 



Rear Admiral Edward C. Kenney MC USN 
Surgeon General 
Rear Admiral A. S. Chrisman MC USN 
Deputy Surgeon General 

Captain M, W. Arnold MC USN (Ret), Editor 

Contributing Editors 

Aviation Medicine Captain C. E. Wilbur MC USN 

Dental Section Captain C. A. Ostrom DC USN 

Occupational Medicine CDR N. E, Rosenwinkel MC USN 

Preventive Medicine Captain J. W. Millar MC USN 

Radiation Medicine CDR J. H. Schulte MC USN 

Reserve Section Captain K. W, Schenck MC USNR 

Submarine Medicine CDR J. H. Schulte MC USN 



Policy 

The U. S. Navy Medical News Letter is basically an official Medical Depart- 
ment publication inviting the attention of officers of the Medical Department 
of the Regular Navy and Naval Reserve to timely up-to-date items of official 
and professional interest relative to medicine, dentistry, and allied sciences. 
The amount of information used is only that necessary to inform adequately 
officers of the Medical Department of the existence and source of such infor- 
mation. The itenM used are neither intended to be, nor are they, susceptible 
to use by any officer as a substitute for any item or article in its original 
form. All readers of the News Letter are urged to obtain the original of those 
items of particular interest to the individual. 

Change of Address 

Please forward changes of address for the News Letter to: Commanding Officer, 
U. S. Naval Medical School, National Naval Medical Center, Bethesda, Maryland 
20014, giving full name, rank, corps, and old and new addresses. 



The issuance of this publication approved by the Secretary of the Navy on 
28 June 196 1. 



Medical News Letter, Vol, 43, No. 4 



Mosquito -Borne Epidemic Hemorrhagic Syndromes * 

Robert Goldsmith MD, Research Fellow, ICMRT, Hooper Foundation, 
University of California Medical Center. {Presenting for Albert Rudnick 
PhD). 

The first major outbreak of the hemorrhagic fever syndrome occurred in 
Manila in 1956. Characterized by hemorrhage and fever, the disease caused 
750 hospitalized cases; the mortality rate was 10%. Two years later, a sim- 
ilar disease occurred in Bangkok and recurred in I960 and 1962. In Singapore, 
in I960, another hemorrhagic fever outbreak was observed, although the dis- 
ease differed. Other hemorrhagic fever syndromes have been reported during 
the last 20 years. They have been divided into six groups depending upon geo- 
graphic distribution and upon the vectors involved: First, the hemorrhagic 
fever with renal syndrome seen in Korea, and thought to be mite -borne. 
Second, The Argentine hemorrhagic fevers, then the tick-borne group, includ- 
ing Southern Soviet hemorrhagic fevers, Russian Spring-Summer encephalitis. 
Next the mosquito -borne dengue group, and last, yellow fever. 

Three epidemics of hemorrhagic fever have occurred in Bangkok in 
1958, I960, and 1962 involving, respectively, 2000, 2000, and 4000 cases. 
The original mortality'rate of 10% has, by prompt hospitalization of affected 
persons, been reduced to 5%, Since knowledge of the disease is based on 
hospital cases, the total spectrum of the disease is unknown. The epidemics 
begin in May, reach a peak in July and August, then gradually decline, and 
disappear in November. This pattern corresponds with the monsoon season 
when mosquitoes are most prevalent. Yet the disease is urban. Urban mos- 
quitoes in the area are Aedes aegypti and Culex fatigans ; the prevalence of 
Aedes is independent of external rainfall. Another interesting feature of the 
disease is its age-specific distribution; it has not been described in persons 
over 14 years; the modal age is 3 or 4 years. Perhaps only children show 
severe nnanifestations, although all persons are affected. It may be that 
adults have been immunized by dengue 12 to 14 years earlier. This is not 
known. The disease is a problem only in urban areas, and factors of race 
and sex have not proved to be significant. 

Clinically, the disease may involve a child, usually Chinese or Thai, 
3 or 4 years old. On the first day, fever, cough, headache, vomiting, or 
abdominal pain may occur, but the child does not appear seriously ill and is 
usually still eating and ambulatory. Two days later, the child is definitely 
ill, anorexic, not walking around, weak, and restless. The face is flushed; 

* This is the fifteenth paper from the Tropical Medicine Symposium, USNH 
Oakland, Calif. , March 14 and 15, 1963. The preceding papers were 
published in the Medical News Letters of 15 November and 6 December 
1963, 3 January and 7 February 1964. Edited by Captain Arthur J. Draper 
MC USN; authorized by the CO of the Hospital, Rear Admiral Cecil L. 
Andrews MC USN. 



4 Medical News Letter, Vol. 43, No. 4 

there is conjunctival injection. Hepatomegaly and the first peripheral 
petechiae may be observed. A tourniquet test done at this stage would be 
positive. Petechiae occur in 70% and hepatomegaly in 60% of all cases. On 
the fourth day, shock supervenes in 10% of cases. The mechanism is unknown, 
although it does not appear to be adrenal in origin. Other hemorrhagic phe- 
nomena become manifest, more petechiae, purpura, epistaxis, hematemesis, 
and nnelena. On the fifth day, half of the patients are in shock; 5% of those 
affected by the disease, die. The remainder rapidly recover leaving the hos- 
pital on the 7th or 8th day. There are no sequelae. 

Laboratory data are not helpful. Thrombocytopenia is seen, but leu- 
kopenia or leukocytosis is variable. Turk cells may be present in blood 
smears. Hemoconcentration is hard to evaluate because the child takes little 
fluid. Bone marrow aspirates show adequate numbers of megakaryocytes with 
maturation arrest. Some cases have bronchopneumonia, some, abnormal 
liver function. At postmortem, gross petechial hemorrhages are seen in all 
organs. Serous effusion occurs into pericardial and abdominal spaces. Also 
observed have been interstitial pneumonia, granulomatous lesions in the 
spleen, and fatty degeneration in the liver. 

Treatment is entirely symptomatic. After observation of hemorrhage, 
fever, hepatomegaly, and shock, diagnostic measures include isolation of the 
virus and serologic studies. Virus isolation must be accomplished within the 
first 3 or 4 days of illness. It is a long arduous process, not employable as 
a routine measure. Serologic technics are available but identification of the 
causative organism is complicated by cross -reactions with other dengue 
viruses — 1, 2, 3, or 4. 

The etiology of hemorrhagic fevers has not been definitely established. 
More than half the isolations from ill patients have shown dengue viruses. For- 
merly thought to consist only of types 1 and 2, the dengue group has been shown 
recently to contain types 3 and 4, or even 5 and 6. A large number of isola- 
tions have grown Chikungunya virus from group A arthropod-borne viruses. 
From Aedes mosquitoes in urban areas, dengue types 2, 3, and 4, as well as 
Chikungunya have been grown. The last has been isolated once from Culex 
fatigans . Has a new virus been introduced from outside the area? Have 
dengue types 1 and 2 undergone kinetic variation and selection with resultant 
production of more virulent types? Has host susceptibility changed? Have 
enzootic viruses for some reason slipped over into the human population? 
Have environmental factors changed, permitting a low rate of human infection 
to become epidemic? 

Control measures should be directed against eradication of Aedes 
aegypti and protection of patients during the viremic stage of illness, the first 
4 days, from nnosquitoes. 

>!i i}! ^ ^ $ >;e 



Medical News Letter, Vol. 43, No, 4 5 

Developmetits in Virology 

Ernest Jawetz MD PhD, Professor of Microbiology, University of 
California Medical Center. 

A virus is generally thought of as a miasmatic creature which is vaguely 
threatening. However, there have been marked advances in the ideas of viral 
morphology. It was found years ago that when one sectioned cells infected by 
viruses and looked at the particles, the particles were often arranged in pecul- 
iar crystalline arrays. It was tempting actually to isolate crystals of multiple 
virus particles. From this point, investigators progressed to the examination 
of individual virus particles which were also seen to be constructed along crys- 
talline lines. A variety of crystalline symmetries was seen to prevail. A given 
particle presumably has on its inside nucleic acid, on the outside, protein; 
the particle is cleverly constructed along a 5-3-2 series of symmetrical axes. 
At times, the individual protein units are ball-like, at other times, they seem 
to be hollow cylinders. Some particles are arranged in peculiar vesicular 
structures, viz. , chickenpox. The general appearance of a virus is thus far 
removed from the miasmatic creature of the imagination. 

By the time a viral disease has actually been recognized, most of what 
has gone on structurally in the virus particles has already happened. When a 
patient becomes infected, the virus multiplies in a series of cycles in suscep- 
tible cells; there tends to be a stepwise increase in the total viral population 
of the body. The patient, however, is frequently alntiost well or virtually well 
until the nonspecific prodrome occurs. At that time, there is a maximal 
virus concentration in the body, and the virus is then present in the blood. By 
the time the doctor sees the patient, things are likely to be over with. In most 
viral diseases the damage has been done to those cells that are going to be 
damaged. Therefore, at the time that a physician observes the measles rash, 
the chickenpox lesion, the common cold, or whatever the specific manifesta- 
tion, viral m.ultiplication has largely finished. If the physician wishes to make 
a specific diagnosis, he must get an early grip on the patient and catch the 
area when there are still lots of viruses present, or one has to rely on the rise 
of antibody titer which follows the actual viral disease. 

Viral recovery should, of course, be mentioned. First, it is necessary 
to have a clinical impression, the earlier the better. For isolation of viruses, 
various systems of whole cells miust be available, ranging from tissue culture 
through man. Demonstration of a rise in antibody titer, too, should be 
attempted. Recovery of a viral agent or demonstration of a rise in antibody 
titer do not, of course, indicate that this particular agent caused the disease. 
As an example of diagnosis by these methods, let us consider the case of a 
small boy with a nasty-looking eczema on the top'of which are many vesicular 
lesions. These might represent a varicelliform eruption; it could be anything, 
but is most often chickenpox or herpes simplex. Scrapings from the base of a 
vesicle stained with Giemsa show multinucleated giant cells, a reaction which 
is suggestive of involvement by DNA viruses. Failure of the virus to grow on 



6 Medical News Letter, Vol. 43, No. 4 

egg membrane suggests chickenpox; growth suggests herpes simplex. The 
specific neutralizing antibody titer rises later. 

In discussing the clinical diagnosis of respiratory viral disease, the 
clinical exannples are considered. Patient A arrived at a ski resort feeling 
fine. After a day of brisk skiing topped off by a swim, he felt very tired as 
he crawled fronci the pool. Next morning, he had a dry throat, felt chilly 
and had a splitting headache together with vague chest pain. Then began 
a train of symptoms classically attributed to influenza, frontal and retro - 
orbital headache, chest pain, generalized aches and pains, particularly deep 
aches in bones and joints. None of these signs, of course, are specific for 
influenza; the only specific sign, cited by Dr. Arthur Bloomfield, is lack of 
cheer. At all events, the disease in patient A pursued its course for several 
days, ending in fairly abrupt improvement. At this time, in the ski resort 
there were approximately 350 people with the same disease. It is important 
to emphasize that only a minority of patients show the full-blown clinical pic- 
ture. Patient B, a close friend attendant on patient A, had truly mininnal 
signs of infection which would not have been diagnosed had it not been for a 
subsequent rise in subtype-specific antibody titer. Patient C, another close 
friend and physician to patient A, had an illness of intermediate severity. 
Those who are clinically ill are poor spreaders of the disease; they are off 
in bed, too sick to spit in the vicinity of other persons. Those who are rela- 
tively well, however, are very good spreaders of the disease. 

Other viral diseases can certainly mimic influenza. Having the "flu" 
may be taken to mean that the patient has an illness which is bacterial in 
nature, although infectious, and from which prompt recovery may be antici- 
pated. Another such illness began in the case of a house officer when he 
noticed, while shaving, a large pre -auricular lymph node. Comcomitant fol- 
licular conjunctivitis was observed by a colleague in the Eye Clinic. Next 
day, he had a sore throat, the day after, a little fever. His eyes began to 
really hurt. "Typical adenovirus infection" was the diagnosis, confirmed 
by rises in antibody titers. The point of the presentation is that one serious 
respiratory infection cannot by clinical means be distinguished frona another. 
Most useful in diagnosis is the associated sign; in adenovirus infection, the 
eye lesion provides the clue. 

The adenovirus group provides an example of how different types of 
a given brand of virus may give rise to different natural histories and differ- 
ent clinical manifestations. Adenovirus types 1, 2, 5, and 6 cause infections 
practically always of smiall children and tend to survive subsequently in lym- 
phoid tissue. Practically every adult now present at this discussion could be 
shown to have adenovirus residing in the lynnphoid tissue. Type 3 is a moder- 
ately frequent cause of an infection in older children often called "swimming 
pool conjunctivitis. " Types 4 and 7, for unknown reasons, cause infection 
only in military personnel. It has not been described in college students of 
the same age. Specific eye infection, usually in adults, is caused by type 8. 
Severe systemic illness does not occur, but the eye difficulties may be rela- 
tively long -lasting. That multiple types existing in many kinds of different 
viruses may have relatively distinct patterns of natural behavior, as well as 



Medical News Letter, VoL 43, No. 4 7 

clinical manifestations, is not impossible to understand, when one reflects 
that many of these viruses affect types of tissue with very limited ability to 
respond. The syndrome of the common cold, for instance, may be provoked 
by a vast number of influences, emotional stress, atmospheric irritants, 
chemical irritants, allergens, and a host of infectious agents. The response 
of the upper respiratory tract to insults is limited. What can a nose do? It 
can run or it can stop up ! 

There have been some new developments in the field of therapy. De- 
spite the human need for treatment of an ailment, prescription of antibiotics 
or chemotherapeutic agents is of no value. Research is directed toward 
Interruption of the virus cycle of infection. If a virus particle is absorbed 
onto a cell, it usually injects its nucleic acid or the whole particle enters. 
Cycles of multiplication then occur. Before the cycle of multiplication can 
occur, however, the protein and nucleic acid have to become uncoupled; the 
nucleic acid or the virus particle instructs the synthetic machinery of the 
cell to make "virus nucleic acid" rather than cellular material. Once this 
has been done, the virus nucleic acid in some way influences future protein 
synthesis. If all goes well for the virus particle, these two will be reassem- 
bled with the result that fully infectious viral particles may be produced and 
released from the cell. The cycle may be interrupted by administration of 
gamma globulin; given at the right time after exposure in the right amount, 
gamma globulin can suitably coat the virus particles. Such a preventive 
measure has been used in measles, infectious hepatitis, German measles, 
questionably in chickenpox, and rarely effectively in poliomyelitis. Coating 
the virus particle with specific antibody prevents its entry into the cell. 

At the next step, spontaneous blocking may occur. Synthesis of new 
nucleic acids is blocked by a protein that forms in the cell under the influence 
of active or inactive virus. Called "interferon, " this protein has reasonably 
well defined molecular characteristics. In some way it specifically interferes 
with the synthesis of new virus. Its development in viral therapy, if properly 
prepared in large concentrations, is limited by two big problems. One, inter- 
feron is host specific, although it acts against all kinds of different viruses; 
two, its available concentration in lots thus far prepared is extremely low. 
A third place where active interference, in a treatment sense, with virus 
diseases inight be considered is in the preparation of analogues of the build- 
ing blocks of nucleic acid. If these analogues are improper, an inactive fraud- 
ulent nucleic acid may result that cannot function biologically. The limitation 
of the method lies in the fact that the nucleic acid of the synthesized viruses 
is of necessity closely related to the nucleic acids of the whole cell. 

Although assumed for many years that this method would not work, it 
has recently been shown that experimental herpes simplex in the rabbit eye — 
which produces a large dendritic ulcer — will resolve if the analogue 5-iodo- 
2-deoxy-imidine is applied topically. Effects of viral multiplication have been 
interfered with even after the lesion had become established. Human herpetic 
eye lesions can be suppressed even though the material is given late in the 
disease. There may be diminished synthesis of new virus, but not total sup- 
pression. The answer to treatment of many viral diseases is still forthcoming. 



8 Medical News Letter, Vol. 43, No. 4 

Scrub Typhus 

J. Ralph Audy MB PhD, Professor of Tropical Medicine and Human 
Ecology, Hooper Foundation, University of California Medical Center. 

Since time does not permit discussion of the rickettsioses as a whole, this 
presentation concerns the distribution of scrub typhus, the sequence of 
events leading to infected foci, and the course of the disease in the infected 
person. 

Epidemic louse typhus and flea typhus are urban and worldwide in dis- 
tribution. The various forms of tick typhus, on the other hand, have each 
evolved locally in some fixed host association. Hence, differently named 
diseases and different subspecies of tick occur. Scrub typhus differs in being 
the only tick-borne rickettsiosis geographically restricted to one region, from 
Japan to Australia. Survey of a regional map showing distribution of this dis- 
ease reveals blank areas that have not been investigated, areas in which the 
disease is passing, and regions in which it is endemic. Within these last are 
very small restricted foci which represent the epidemiologic infective units. 

In Japan, for instance, classical scrub typhus transmitted by tsutsuga- 
mushi is restricted to one area. In that geographic region there are a number 
of endemic and a few relatively endemic sub -regions which follow the courses 
of certain rivers where they debouch onto the plains and are constantly flood- 
ing. Within an enlargement of an endemic part, dots appear representing 
confirnned infected foci. These are called typhus islands. 

Abandoned areas of cultivation, whether palm, rubber, or tobacco 
plantations or simply primitive agriculture, become covered with dense 
undergrowth affording cover for a large rodent population. This is the begin- 
ning of an infected focus. The cycle of infection commences. 

Mites, Trombicula akam^ushi or deliensis , are the vectors which 
transmit R. tsutsugamushi . Out of its eggs come little 6-legged larvae, 
chiggers, that normally feed on small rodents and birds. The engorged chig- 
ger drops off in 2 or 3 days and becomes a pupa. Out of the pupa comes an 
adult form of tick which is not parasitic but feeds on soil arthropods. It is 
sexually immature. Next comes another pupal stage followed by the sexually 
mature adult form. Fertilization of the female causes her to lay eggs. The 
larvae which emerge from the eggs may be restricted to very small patches 
of soil. They may gather on the top of a leaf where they are just visible to 
the naked eye as little specks of reddish dust. Any animal brushing by this 
leaf acquires chiggers. Another type — near Tokyo — congregates on small 
volcanic rocks. The normal animal host is the rat; as many as four hundred 
chiggers may infest one rat. Man is the incidental host. 

Man is seldom exposed to sylvatic or jungle scrub typhus. The causa- 
tive mites are either scarce or arboreal in the wild. The major vectors 
belong to a ground -dwelling genus, Leptotrombidium , previously alluded to 
by the former name Trombicula . Both the akamushi species— distributed 
from Japan to New Guinea including Malaya — and the deliensis are vigorous 



Medical News Letter, Vol. 43, No. 4 9 

enthusiastic vectors which flourish in wasteland, especially in grassy land. 
They give rise tothe classical disease in the classical terrain at the classical 
season of warm wet weather. Some purely local species of L, e pt ot r ombidi um , 
however, especially in Japan, cause unexpected outbreaks in widely different 
places. Local subspeciation of rickettsia occurs; recently in Malaya, for 
example, scrub typhus has been found in coastal sandy areas quite different 
from the classical environment for transmission of this disease. 

The course of the disease in man follows inoculation by an infected 
chigger. The rickettsiae multiply at the site of biting and rapidly beconcie 
distributed. A local lesion, a small ulcer with later formation of eschar, 
occurs and there is an associated rickettsemia. The organisms nnultiply 
mostly in the lining of the smaller blood vessels; the organ they settle in and 
their virulence determine the course of the disease. Classical typhus pre- 
sents — like early measles — flushed face, conjunctival injection, weeping eyes, 
a rapidly developed typhoidal state with lack of cheer and intoxication. Then 
a rash appears; in scrub typhus it involves the trunk. It is small, patchy, 
maculopapular or macular. A slight amount of rickettsial pneumonia occurs. 
Cough is characteristic. Cardiac involvement and encephalitis may occur. 
Laboratory diagnosis by the Weil-Felix reaction is important, but the rise in 
titer may be late — several weeks after onset. In some epidennics, the reac- 
tion has been consistently negative. 

Standard treatment with tetracycline or chloroamphenicol must be 
pursued if started at the very beginning of illness or relapse may occur. 
Long continued small doses are reconnmended. In a desperately ill patient 
well into the second week of illness, even one large dose, especially if com- 
bined with corticosteroid, may be effective. 

Control of scrub typhus may involve personal prophylaxis by impreg- 
nation of clothing with mite repellents, dimethyl or dibutyl phthalate, benzyl 
benzoate or area control. The Japanese are trying a polyvalent vaccine. 
Drug prophylaxis is not advised. Area control may be achieved by chemical 
sprays. An area repeatedly causing trouble maybe bulldozed and placed 
under cultivation. Rat control should never constitute the initial step; if rats 
are removed from an infected focus, the chiggers will feed on human beings. 
Following area control by chemicals, rat control should be carried out. 

Jjf -y -T- ^ '^ 

Rabies - Problems and Progress 

Orlando A. Soave DVM, Assistant Professor of Preventive Medicine, 
Stanford University School of Medicine. 

Rabies is a disease that affects all mammals including man. It is caused by 
a relatively large virus which is usually shed in the saliva of infected animals 
and transmitted by the act of biting. The disease has been recognized for at 
least 2500 years. Democritus, in 500 B.C., and Aristotle in the Fourth 
Century B. C. , gave excellent clinical descriptions. In the first Century A, D. , 



10 Medical News Letter, Vol. 43, No. 4 

Celsus recognized the relationship of rabies in animals to hydrophobia in man 
and recommended cauterization of wounds. Since these early descriptions, 
the disease has been reported in all parts of the world except Australia and 
the Hawaiian Islands. The absence of rabies in these areas is not as yet ex- 
plained. Some observers believe that, possibly, it is because certain species 
of maintaining reservoirs, such as Mustalidae and Viverridae, the skunk and 
weasel families, are absent from these areas. In the United States during 
1961, the disease in animals was reported in 39 States, and in 1962, 3 more 
States reported it. About 3500 animal infections were reported in 1961, in- 
volving — in addition to wild animals —dogs, cats, cattle, and horses. 

From the site of the wound, the rabies virus gains entry to the central 
nervous system, ostensibly via the nerve tracts. Viremia has not definitely 
been shown. Once the virus reaches the central nervous system it produces 
an encephalitis. Neuronal degeneration, neuronophagia, gliosis, perivascu- 
lar cuffing, and cerebral edema occur. Intracytoplasmic inclusion bodies, 
Negri bodies, appear within the neurones as magenta- staining spots which, 
in turn, contain basophilic granules. Demonstration of the inclusion bodies 
is diagnostic. 

Although rabies continues to receive tremendous publicity, the inci- 
dence of the disease in dogs and domestic animals has been declining for 10 
years, during which time fewer than 10 human fatalities have occurred each 
year. Vaccination of domestic animals is the primary reason for this decline. 
The incidence in wild animals, by contrast, has increased, particularly in 
skunks and, to a lesser degree, in raccoons, opossums, and bats. The dis- 
ease is now much more common in foxes than in dogs. 

Attempts to control rabies in the wild animal population have not been 
rewarding. Trapping and poisoning have not been satisfactory and probably 
do not constitute a desirable approach. The search for a "true reservoir" 
that can harbor the virus for long periods and transmit it at various tinries has 
not been completely rewarding. Some species of bats may serve as a main- 
taining reservoir, but it is not known how often contacts occur between bats 
and other animals proved to be rabid, how often terrestrial animals inhabit 
bat caves, nor why wild animal rabies is common in areas containing no large 
bat caves. 

The possibility that rabies virus can survive in sonne species of animal 
as a latent infection must be entertained. If this agent exists in some animals, 
as do the viruses of herpes simplex in man or B virus in monkeys, the demon- 
stration of such a relationship would clarify some of the epidemiologic ques- 
tions regarding this disease. Under experimental conditions, the virus has 
survived eight and one -half months in guinea pigs, having been reactivated by 
stress factors. Spread by airborne infection or by contact with infected urine 
have been suggested. Animals in Carlsbad Caverns — where millions of bats 
roost— were protected from arthropods and contact with bats by screened 
cages. They subsequently developed rabies. 

In man, the dominant problem with respect to rabies is fear. The 
annual nnortality rate in the United States is extremely low. The principal 



Medical News Letter, Vol. 43, No. 4 11 

reason for fear, then, is that for the individual patient, once symptomatic, 
nothing can be done. 

The epidemiology of aninnal bites is a fascinating study. Seven hundred 
thousand persons in the United States are bitten by animals according to the 
annual reports. The physician attending a bitten person should first determine 
the animal involved. Skunks, bats, and foxes are commonly rabid; squirrels 
and rats, rarely. Should a dog be involved, the incidence of rabies in the 
community must be considered. The animal should be quarantined; if infected, 
it would die within 10 days. The type and location of the bite, whether the pa- 
tient has previously been given Pasteur treatment, and whether hypersensitiv- 
ity to vaccine exists should be determined. 

Also, the economic factor must be considered. More than 30, 000 
anti-rabies treatments are given annually in the United States at a cost of 
more than three million dollars. This expenditure is an index of the anxiety 
aroused by the disease. Another source of consternation is postvaccinia! 
reaction, although it occurs in only 0.1% of cases. Duck embryo vaccine was 
developed to avoid this reaction, but success in its use is open to question. 
The speaker has personal knowledge of three deaths following vaccination with 
duck embryo vaccine. In each instance, the period from bite to death was long 
enough so that antibody response would have been anticipated. One other case 
of postvaccinia! encephalitis attributable to this agent has been reported. 

Progress in the study of rabies is represented by (!) the development 
of fluorescent antibody staining technics for demonstrating the virus in infect- 
ed brain tissue, and (2) by the development of chicken embryo propagated live 
virus vaccine for use in immunizing dogs and cattle. The discovery of possi- 
ble aerosol spread of rabies virus is another advance. Whether this phenome- 
non occurs in nature is being investigated. 

Investigation of strains of virus isolated from nature that exhibit low 
virulence in inoculated laboratory animals is being carried out. 



Chagas' Disease . The clinical and epidemiologic importance of Chagas' dis- 
ease justifies its inclusion in the public health plans of the countries where 
it is prevalent. The disease can attack the foetus in the womb, particularly 
affects children under 5 years, and causes important digestive and cardiac 
lesions in adults. The prevalence of the disease is largely due to poor quality 
rural housing and widespread ignorance of the part played by vectors in its 
transmission. The following were among measures recommended: spraying 
programs for eradication or reduction of Triatoma ( T . megista) in dwellings 
(these would follow the completion of malaria eradication operations and use 
the same teams); reconstruction or repair of rural dwellings; epidemiologic 
surveys to assess the extent of the problem; and wider research on the patho- 
genesis, diagnosis, epidemiology, and therapy of the disease. 

— WHO Chronicle. Health Problems of 
the Americas 17(11):416, November '63 



12 Medical News Letter, Vol. 43, No. 4 

SUBMARIIME MEOICI^iE SECTIOIV 




CLINICAL PROBLEMS OF SCUBA DIVING 

Captain George F. Bond, MC, U. S. Navy 
Officer in Charge, Medical Research Laboratory 
U. S. Submarine Base, Nev London, Connecticut 

Clinical Problems of SCUBA Diving 

Since the introduction of self-contained unden*ater breathing apparatus 
(SCUBA) in the early 1950' s, production and use of this diving equipment have 
increased at a truly fantastic rate. Although precise figures are not avail- 
able, it is estimated that the number of civilian sports divers employing 
SCUBA gear number nearly one quarter million people in America today. Consid- 
ering the physiological range covered by these sports divers, and in view of 
the inherent dangers of compressed-air diving, the emergence of clinical prob- 
lems peculiar to SCUBA use was predictable. Because the pathology of hyper- 
baric exposure is so remote from commonly encountered clinical syndromes, med- 
ical practitioners are generally not prepared to cope with the accidents which 
result from this type of diving. In this context, a brief summary of major 
clinical problems of SCUBA diving may be in order. 

Ffeysical Requirements 

Any approach to the medical hazards of compressed-air diving must com- 
mence with the basic, preventive question of candidate selection. Unlike the 
diving medical officer in the Navy, the civilian practitioner is taxed with an 
extremely difficult range of human beings who present themselves for medical 
approval relative to diving activities. At first thought, it might seem easy 
to eliminate all applicants who are overweight, over age, hypertensive, neu- 
rotic, or victims of chronic respiratory disorders. In civilian practice, 
however, the problem is not thus easily resolved. The would-be SCUBA diver 
will probably pursue his xmderwater activity, regardless of physical defects 
determined by examination. The physician, therefore, must accept the role of 
adviser, shorn of normal dictatorial powers. Enlightened advice, however, may 
avert casualties, and such advice is best received from the family doctor. 

Evaluation of the potential SCUBA diver should probably be predicated on 
the likelihood that most candidates will dive regardless, and can best be serv- 
ed by a careful evaluation of the physical disabilities which may limit or pre- 
clude this activity. Since most diving casualties relate to abnormalities of 
the respiratory system, this is a prime object of surveillance. Problems rel- 
ative to the middle ear and paransaal sinuses can rarely be predicted by or- 
dinary examination. Ability of the individual to equalize pressure in these 
areas is probably best determined by a test of pressure, in an available cham- 
ber, or in underwater trial. In case of the lungs, however, the practitioner 

Reprinted from Connecticut Medicine , June 1963 Issue, Vol. 27, No. 6, 
page 312. 



Medical News Letter, Vol. 43, No. 4 13 

has better selective control. Any pulmonary lesion, such as cystic lung dis- 
ease or healed extensive pulmonary histoplasmosis should be immediately and 
permanently disqualifying. The reason for this should be made clear to the 
patient: any condition which could lead to general (as in asthma) or localiz- 
ed trapping of air in the lungs, can result in a fatal case of arterial air 
embolism vith a relatively minor pressure fluctuation. In addition, but of 
lesser importance, is the fact that impaired puljnonary function predisposes to 
increased carbon dioxide retention and development of decompression sicJoxess, 
or "bends." Concerning the cardiovascular system, it may suffice to point out 
that underwater swimming with SCUBA gear is a most demanding physical exer- 
cise, comparing nicely with kkO and 880 yard competitive runs. If the candi- 
date's cardiovascular system is inadequate for such a stress, he should be ad- 
vised against SCUBA diving. Consideration of other body systems should be pre- 
dicated on the simple fact that SCUBA swimming is hard work for the entire or- 
ganism; the candidate should be impressed with this fact. Finally, the doctor 
and patient alike must understand that an underwater environment is both un- 
natural and hostile, and that any degree of emotional instability will increase 
the probability of dangerous accident. 

Major Clinical Hazards 

The major clinical hazards of SCUBA diving are threefold: arterial air 
embolism, bends, and drowning. Although the teiminal fatal event is generally 
drowning, the proximate cause not infrequently can be traced to air embolism 
or massive and generalized bends. Because of popular confusion between bends 
and air embolism, it is important to describe these entities in more detail. 

Air embolism occurs when massive quantities of inspired gas are forced 
through the alveolar cellular wall, to proceed via interstitial pathways toward 
the mediastinum. In this process, the gas may be forced into the pulmonary 
venous system, or else dissect into the loose tissues of the mediastinum. 
Should, the gas enter the pulmonary venous system, it will pass directly to the 
left ventricle, and thence ultimately to the cerebral vessels, with blockage 
of circulation throughout the circuit. The quantities of gas which enter the 
circulation under these circumstances are massive, indeed. On at least one 
occasion, we have calculated more than one liter of air in the heart, aorta, 
and cerebral vessels of a fatal casiialty. Treatment of air embolism consists 
in inmediate recompression to a chamber depth of 165 feet, which reduces the 
intra-arterial gas volume by five-sixths, permitting resumption of normal blood 
flow. Subsequently over a period of thirty-five hours, reduction of pressure 
penaits safe return to surface environment after the residual gases have been 
dissolved in the blood stream of the individual, and eliminated through the 

lungs. 

It is unlikely that, in absence of recompression facilities, medical 
therapy will be of real value in treatment of an actual case of arterial gas 
embolism. The role of the practitioner, therefore, is that of a preventive 
adviser, since his judgment of potential pulmonary air trapping may be of 
critical importance to the diving candidate. In the event of a fatal occur- 
rence of air embolism, however, it is vital that a meticulous autopsy be per- 
formed. Presently, SCUBA deaths are invariably labelled as drowning, and 
autopsies are not obtained j thus, the casual factor of air embolism is not 
documented. The incidence of fatal embolism cases in the Navy is fortvmately 
small. It follows, therefore, that good information relative to this clinical 
entity is scarce- Additional autopsy findings which could be acquired in 
cases of civilian casxialties would be of inestimable value in overall evalua- 
tion of the syndrome. More importantly, some estimate of the role of air em- 
bolism in SCUBA deaths mi^t be available. 



14 Medical News Letter, Vol. 43, No, 4 

Decompression sickness, caisson disease, or "bends," represents a clini- 
cal syndrome quite distinct from arterial air embolism. As previously describ- 
ed, air embolism results frcan intra-arterial introduction of massive qiiantities 
of gas vhich passes through, alveolar walls and terminates as emboli in the 
cerebral vessels. In the case of "bends," however, a different physical phe- 
nomenon is involved. The diver who breathes compressed air vinder increased 
ambient pressure will inevitably have a degree of nitrogen dissolved in his 
blood stream and tissues, depending ba the depth and duration of the dive. 
Upon ascent, this inert gas must be eliminated through the lungs, or else come 
out of physical solution, producing gas bubbles. Such bubble formation in 
turn produces intravascular blockage or cellular distortion, either of which 
will result in tissue anoxia and pain. This pain, ccsnmonly centered in areas 
of poor vascularity, is the characteristic of divers' bends. Most likely 
sites of election are joint areas of the extremities, with rare involvement of 
the spinal cord. 

In the treatment of "bends," as in the case of air embolism, recanpres- 
sion of the patient is a necessity. Because "bends" does not present a com- 
parable hazard to life, however, a good deal of latitude is allowed in the 
time interval between accident and pressure treatment. Delays of several 
hours may be dictated by the distance to nearest recampression chamber. Such 
a delay will somewhat modify the therapeutic result, but it is important to 
emphasize that even greatly delayed treatment of bends will generally result 
in great improvement or total cure. If a delay is anticipated before delivery 
of the patient to a pressure facility, administration of opiates may be re- 
quired for control of severe pain, although apparent improvement due to such 
drugs in no way changes the requirement for reccanpression treatment. 

Minor Clinical Hazards 

Although the practicing physician will not often be confronted with major 
diving accidents, his advice and treatment will frequently be sought in con- 
nection with minor casualties of everday diving. Almost invariably these de- 
rangements will result frcan unequal pressure differentials in the paranasal 
sinuses or the middle ear. During descent in the water, external pressure on 
the body will increase at a rate of about one-half pound for each foot of de- 
scent. Clearly, if this pressure is not equalized in the middle ear and si- 
nuses, an xmequal pressure differential will exist. In such a case, severe 
pain will be experienced, and accompanied by extravasation of blood and serum 
into the closed cavity. Because pressure equalization during ascent is easy 
and automatic, relief of pain is achieved by return to the sxirface. The div- 
ing enthusiast now presents himself to the physician for diagnosis, treatment, 
and advice relative to future diving activities. The history of a recent 
dive, coupled with evidence of esctravasated blood in the middle ear or si- 
nuses, will make the diagnosis simple, and in practically all cases active 
therapy is not required. The question of future diving activity, however, is 
not so simply resolved. Generally speaking, occurrence of ear or sinus 
squeeze at rare intervals should not be contraindication to further diving 
activities, and might be considered a minor occupational hazard of the sport. 
Persistent inability to equalize pressure, however, may permanently disqualify 
the subject for further pressure exposure. In selected individuals, radiation 
of lymphoid tissues near the eustachian ostla will ultimately permit normal 
equalization of the middle ear, and suitable therapy for chronic or acute si- 
nusitis may guarsmtee equalization of these cavities. Generally speaking, the 
ability to "clear" the ears is a function of time and practice, making prog- 
nostication difficult in any event, and occasionally embari^ssing. 



Medical News Letter, Vol. 43, No. 4 



15 



Summary 

In brief narrative, an attempt has been made to elicit major and minor 
clinical hazards of SCUBA, diving. With the predictable increase in numbers 
of diving enthusiasts, physicians throu^out the United States will be expect- 
ed to understand and treat the pathologic results of pressure exposure. 
Familiarity with these syndromes will improve the effectiveness of the medical 
practitioner with respect to advice as well as treatment. 



Seven references are cited in the original article. 



^r* "t" 'f 




MISCELLANY 



Information for All Persons Going on TAD 

In the interest of conserving ternporary additional duty travel funds, Com- 
manding Officers are reminded of certain provisions of Joint Travel Regula- 
tions regarding government quarters. Paragraph 1150-5 defines the term. 
government quarters, as used in the regulations, as any sleeping accomoda- 
tion owned or leased by the U. S. Government provided it is made available 
to, or utilized by, the member concerned. 

Paragraph 4451 requires members in a travel status to utilize available 
governnnent quarters to the maximum extent practicable and provides for 
certification of the Commanding Officer or his representative at the temporary 
duty station as to the nonavailability of government quarters in support of 
claims for the full per diem for temporary duty of 24 hours or more at mil- 
itary installations. 

It has been ascertained that many commands endorse orders indicating 
that government quarters are not available because the available quarters 
are substandard. 

In view of the above provisions, the existence of any available usable 
government quarters providing sleeping accommodations would preclude en- 
titlement to the quarters portion of per dien:i, and an "all out" effort should 
be made to provide sleeping accommodations for members reporting for tem- 
porary additional duty. 

— Published by Direction of the Surgeon General, 

Rear Admiral E. C. Kenney, Medical Corps, U. S, Navy 



* 






16 



Medical News Letter, Vol. 43, No. 4 



FILM LOANS 

The following films have been donated to the AFIP throti^ the gracious cooper- 
ation of the Intersociety Committee for Research Potential in Pathology, Inc., and are 
available for loan to Federal and Civilian scientific requestors. 

AFIP-86 Btectroit Mictoacopy of Noimal and Leukemic Leukocytes 

AFIP-S7 Blood Fractions in Clinical Medicine 

A FIP-S8 Th e Compound Mi cros cope 
• AFIP-S9 Endoscopic Photography of the Ear, Nose and Throat, the Trscheo bronchi el 
Tree and the Esophagas 

AFIP-90 We Speak Again - The Rehabilitation ol Laryngectomized Patients 

AFIP-91 Organic Disorders ol the Larynx 

AFIP-92 Ostoscopic Cinematography ol the Tympanic Membrane and Middle Eat 
' AFIP-93 EsophagoBCOpic Views ol Lesions of the Esophagas 

AFIP-94 Activities of Oligodendroglia 

AFIP-9S Dye Transfer by Renal Tubules 

AFtP-96 Diagnosis of Hidden Congenital Anomalies 

AFtP'9 7 Activities ol Mi croglia 

AFIP-98 Normal Astrocytes (Living Human Cells in Calture'Series) 

AFIP-99 Neoplastic Astrocytes (Living Hatnon Cells in Culture Series) 

AFIP-100 Tuberculosis of the Larynx, Tracheobronchial Tree and Baophagas 

AFIP- 101 Congenital Anomalies of the Larynx 

AFIP'102 Bronchoscopic Cinematography ol Bronchial Tumors 

AFIP-103 Active Anaphylaxis in the Mouse Sensitized with Bovine Albumin - Adjuvant 
Emulsion 

AFIP-104Mitasis of Newt Cells in Tissue Culture 

■ AFIP-IOS Whi te Blood Cells 

AFIP-106 Effects of Metalli c Ions and Osmotic Disturbattces on the Heart 
AFIP-107 Cardiac Arrest 
AFIP-108 Antibiotics 
AFIP-109 Birth ol a Drug 
AFIP'lIOThe Eye ol the Beholder 
AFIP-IllThe World olLile 

AFIP-112 Chemical Balance Through Respiration 
AFIP' 1 13 Principles ol RespiratoTy Mechanics, PL I 
AFIP-1 14 Principles of Respiratory Mechanics, Pt. II 
AFIP'llS Innovations in Transfusion Therapy 
' AFIP-116 Intestinal Obstruction due to Ascaris Lumbricoides 
AFIP'llSThe Ultimate Structure 
AFIP'l27 Action of Human Heart Valves 

■ AFIP-128 Dissection of a Mosquito for Malaria Parasites 



Requests for film should be directed to: 



The AFIP Film & Equipment Exchange 
Washington, D. C. 20305 



* * * * sS :}: 

Meeting of the American College of Physicians 

Medical officers planning to attend the annual meeting of the American 
College of Physicians at Atlantic City, New Jersey, 6-10 April 1964, 
are advised that the Armed Forces tri-service social hoar will be held 
under Air Force auspices on the evening of Tuesday, 7 April, at the 
Madison Hotel. Further details will be available at the meeting. All mil- 
itary officers attending the annual session, their wives, and guests are 
invited to attend. Details concerning the Navy Chiefs of Medical Service 
dinner will be announced in the near future. 

— Medicine Branch, ProfDiv, BuMed 



*& pfe 3J( dq i[s A 



Medical News Letter, Vol. 43, No. 4 17 



Officers' Wives Club Scholarship Award 

The Officers' Wives Club of U.S. Naval Hospital, Oakland, Calif. , announces 
the establishment of annual scholarship awards to be used for education at or 
beyond college level. This award is to be used at any generally accredited 
college or university by an applicant deemed most promising on the basis of 
merit and scholastic promise with financial need to be considered only in the 
case of equally worthy applicants. 

The applicant must be the son or daughter (natural, adopted, or step- 
child) of an officer (Chief Warrant Officers included) in the Medical Corps, 
Dental Corps, Medical Service Corps, or Chaplains Corps, who is now serv- 
ing on active duty in the Regular Navy or on extended active duty with reserve 
status within the limits of the 12th Naval District; or if the officer is deceased 
or retired at the time of application, his last duty station must have been 
within this area. 

The awards are in the form of an outright grant to be made each year 
in an amount not to exceed $300. The number and value of the awards each 
year are determined by the Club based on available funds. These awards will 
become available for the academic year commencing September 1964. 

Application forms may be obtained by mail or in person from the 
Administrative Officer, U. S. Naval Hospital, Oakland 14, Calif. 

Sji ^ * * * « 

MEMBERSHIP IN THE AMA 

The AMA Constitution and bylaws have been amended and now provide for the 
following types of memberships for medical officers on active duty in the Navy: 

1. Active Service Members — Career officers of the Medical Corps of the 
U.S. Navy and U. S. Naval Reserve on extended active duty. Service members 
shall have the same rights and privileges as regular members, but shall not 
be required to pay dues and shall not be entitled to receive Today's Health or 
any scientific publication of the AMA except by personal subscription. 

2. Special Associate Members — Non-career officers of the Medical Corps 
of the U.S. Naval Reserve on active duty. Associate members may attend 
meetings of the Postgraduate Assembly, but may not vote or hold office in 
the AMA. They shall not be required to pay dues and shall not be entitled 
to receive Today's Health or any scientific publication of the AMA except by 
personal subscription. 

The names of all naedical officers on active duty will be submitted for 
membership. No action to obtain membership is necessary by the individual 
active duty doctor Professional Division, BuMed 

9}: :{: 4 $je ^ 3): 



18 Medical News Letter, Vol. 43, No. 4 

FROM THE NOTE BOOK 

Announcement of Correspondence Course 

The Medical Department Correspondence Course, Pharmacy and Materia 
Medica, NavPers 10999-A, is now ready for distribution to eligible regular 
and reserve officer and enlisted personnel of the Armed Forces. Applications 
for this course should be submitted on Form NavPers 992 (with appropriate 
change in the "To" line) and forwarded via appropriate official channels to 
the Connmanding Officer, U. S. Naval Medical School, National Naval Medical 
Center, Bethesda, Md. , 20014. 

This course is based on Chapters 7 and 8 of the Handbook of the 
Hospital Corps, NavMed P-5004. Areas presented are: Basic Pharmacology, 
Review of Toxicology, and Pharmacy. The Pharmacology section outlines 
action, usage, dosage, and side effects, and includes notes of caution on many 
drugs currently used in the Navy. A Review of Toxicology covers basic tox- 
icology, the antidote locker, and treatment for specific poisons. The Phar- 
macy section covers metrology, the prescription, and pharmaceutic prepara- 
tions, processes, and incompatibilities. 

The course consists of seven (7) objective type assignments and is 
evaluated at twelve (12) Naval Reserve promotion and/or nondisability retire- 
ment points. These points are creditable only to personnel eligible to receive 
them under current directives governing retirement and/or promotion of Naval 
Reserve personnel. Personnel who have completed NavPers 10999 will receive 
additional credit for completing this revision. 

— Submitted by Captain J. H. Stover Jr, MC USN, 

Commanding Officer, U. 3. Naval Medical School, NNMC 

yjfi r|v i-fs i^ y^ ^fi 

Medical Department Praised for Job Well Done 

The following is an excerpt from a recent letter from the Director of the 
Naval Sea Cadet Corps to the Surgeon General of the Navy: 

On behalf of the Chairman and the Board of Directors oftheNaval Sea Cadet 
Corps, I would like to express our appreciation to and through you for the 
wonderful support that the naembers of the Medical Department have given 
to our Navy League councils in the support and administration of units of 
our cadet corps in its inception and expansion to 92 activities during the 
past four years. We have enjoyed thousands of Navy standard physical 
exams, and many hours of instruction conducted on a voluntary basis by 
members of the Medical Corps. 

As we continue to expand the program to all of our 468 Naval Reserve 
Training Activities, we will continue to need the volunteer services for 
physical exanninations and instruction of our Sea Cadets who enjoy the 
privileges of training on our Naval Reserve curriculum. 



Medical News Letter, Vol. 43, No. 4 19 



Disestablishment of Formal Training Course in Neuropsychiatric 
Clerical Technic, and Cancellation of the Navy Enlisted Classifi- 
cation Code HM-8444, Nearopsychiatric Clerical Technician . 

"The Bureau of Medicine and Surgery Advisory Board has recommended and 
the Surgeon General approved the disestablishment of a formal training 
course for Neuropsychiatric Clerical Technic, and cancellation of the Navy 
Enlisted Classification code HM-8444, (Neuropsychiatric Clerical Technician). 
Formal training at the U.S. Naval Hospital,- NNMC, Bethesda, Md. , will be 
discontinued upon graduation of the class to be convened 6 April 1964. Addi- 
tional classes to be convened, as promulgated by BUMEDINST 1510.41, have 
been canceled. 

All personnel now assigned the Navy Enlisted Classification code HM-8444 
(Neuropsychiatric Clerical Technician), will be redesignated HM-8485, 
(Neuropsychiatry Technician). The Navy Manpower Authorization, NAVPERS 
576 and the Manual of Navy Enlisted Classifications, NAVPERS 15105-E will 
reflect this change in June 1964. The Bureau will additionally cause this de- 
letion to be reflected in forthcoming changes to the Catalog of Hospital Corps 
Schools and Courses and related publications distributed by BUMED. 

The Bureau of Medicine and Surgery Advisory Board further recommended 
and the Surgeon General approved a policy that training required to provide 
neuropsychiatric clerical services be accomplished by on-the-job training at 
the E-5 (HM2) level, utilizing Neuropsychiatry Technicians currently on board. 
NO medical specialty designation to be assigned. " 

— Hospital Corps Division, BuMed 

****** 
Naval Medical Research Reports 

U.S. Naval Medical Research Institute, NNMC, Bethesda, Md . 

1. The Use of Low Molecular Weight Dextran in Extracorporeal Circulation 
Hypothermia and Hypercapnea: MR 005. 12-0002. 04 Report No. 14, 
July 1962. 

2. Susceptibility of Certain Japanese Mosquitoes to Plasmodium Gallinaceum 
and Plasmodium Berghei : MR 005. 09-1030. 02 Report No, 7. August '62. 

3. Toxic Effects of Oxygen at High Pressure on the Metabolism of D-Glucose 
by Dispersions of Rat Brain: MR 005. 14-3001. 02 Report No. 2, August '62. 

4. Simple Technique for Direct Cannulation of Rat Salivary Ducts: 
MR 005. 12-5000. 04 Report No. 3, September 1962. 

5. The Response of Blood-Fed Aedes aegypti to Gamma Radiation: 
MR 005. 09-1401. 01 Report No. 4, November 1962. 

6. Elevation of Internal Body Temperatures During Transient Heat Loads and 
at Thermal Equilibrium: MR 005. 01-0001. 02 Report No. 1, June 1963. 



20 Medical News Letter, Vol. 43, No. 4 

Naval Medical Research Reports, NMRI, Bethesda, Md. , (Continued) 

7. Structure Vs Toxicity Relationships in Aryl Esters of Tropine and 
V-Tropine. V. MR 005. 06-00 10. 01 Report No. 30, September 1963. 

8. Effect of X-Irradiation in Sub-Lethal to Supra-Lethal Dosage on Serum 
Glutamic Oxalacetic Transaminase: MR 005. 08-5100. 01 Report No. 1, 
October 1963. 

9. Microdetermination of Chloride in Blood Plasma and Cells by Spectro- 
photometric Analysis Using Solid Silver lodate: MR 005. 02-0011. 01 
Report No. 2, December 1963. 

U. S. Naval Medical Research Unit No. 3, Cairo Egypt 

1. Ecological Studies of Phlebotomus Sandflies in the Paloich Area, Upper 
Nile Province, Sudan (Malakal Sub-Unit): MR 005. 09-1605, October 1963. 

2. In Vivo and In Vitro Analysis of the Mechanisms of Pathogenicity in 
Human Schistosonniasis: I. Method for isolation of large numbers of 
schistosome eggs en masse from tissues. Studies on tissue culture and 
chemotaxis: MR 005, 09-1035. 11, November 1963. 

U. S. Naval Air Development Center, Aviation Medical Acceleration Labora - 
tory, Johnsville, Penna . 

1. The Non-Protein Amino Acids and Related Compounds of Rat Liver Mito- 
chondria: MR 005. 13-0002. 7 Report No, 21, October 1963. 

2. A Theory of Ion Transport Across Cell Surfaces by a Process Analogous 
to Electron Transport Across Liquid-Solid Interfaces: 

MR 005. 13-0002. 7 Report No. 24, December 1963. 

3. Psychological Aspects of Water Immersion Studies: MR 005. 13-0005. 7 
Report No. 7, December 1963. 

4. Psychophysiological Aspects of Reduced Gravity Fields: 
MR 005. 13-0005. 7 Report No. 6, December 1963. 

U.S. Naval Medical Field Research Laboratory, Marine Barracks, Camp 
Lejeune, N. C . 

1. Patterns of Illness in Rhinovirus Infections of Military Personnel: 
MR 005.09-1204. 4. 11, November 1963. 

U. S. Naval Medical Research Laboratory, U. S. Naval Subm.arine Base , 
New London, Conn . 

1. Discrimination of Color III. Effect of Spectral Bandwidth: 
MR 005. 14-1001-1. 31 Report No. 410, September 1963. 

2. Speech During Respiration of a Mixture of Helium and Oxygen: 
MR 005. 14-1001-4. 03, October 1963. 

3. Functions of the Medical Officer Aboard a Fleet Ballistic Submarine: 
MR 005. 14-3002-4. 10, Report No. 414, October 1963. 

4. Lighting Survey of USS HARDHEAD (SS365) Memo Report No. 63-12: 
MR 005. 14-1100-1. 15, November 1963. 

5. Autonomic Resiliency, Subjective Symptomatology, and Submarine Stress 
Memo Report No, 63-13: MR 005. 14-2100-3.05, November 1963. 



Medical News Letter, Vol. 43, No. 4 21 

Naval Medical Research Reports, New London, Conn. , (Continued ) 

6, Loudness Discrimination: MR 005. 14-1001-2. 15 Report No, 417, 
December 1963. 

7. Exercise Tolerance Studies in an Artificial Atmosphere Under Increased 
Barometric Pressure: MR 005. 14-3002. 11, January 1964. 

U. S. Naval Hospital, Clinical Investigation Center, Oakland, Calif . 

1. Hydroxyproline Excretion in Endocrine Disease: MR 005. 12-1608, 
September 1963. 

2. An Oral Gelatin -Xylose Test for Estimating Pancreatic Proteolytic 
Activity: MR 005. 12-1608, December 1963. 

U. S. Naval School of Aviation Medicine, Naval Aviation Medical Center , 
Pensacola, Fla . 

1. A Note on the Influeince of Shield Geometry on Air Dose and Tissue Dose 
from Protons Within a Space Vehicle: MR 005. 13-1002 Subtask 1 
Report No. 25, April 1963. 

2. Class Standing at the U. S. Naval Academy as a Predictor of Success in 
Naval Aviation Training: MR 005. 13-3003 Subtask 1 Report No. 37, 
April 1963. 

3. A Brief Vestibular Disorientation Test: MR 005. 13-6001 Subtask 1 
Report No. 82, May 1963. 

4. Excretion of 17-Hydroxycorticosteroids, Catechol Amines, and Uropepsin 
in the Urine of Normal Persons and Deaf Subjects with Bilateral Vestibu- 
lar Defects Following Acrobatic Flight Stress: MR 005. 13-0004 
Subtask 2 Report No. 1, May 1963. 

5. Observation of the Elevator Illusion During Subgravity Preceded by 
Negative Accelerations: MR 005. 13-6001 Subtask 1 Report No. 83, 
May 1963. 

6. The Wolff-Parkins on -White Syndrome as an Aviation Risk; 
MR 005. 13-7004 Subtask5 Report No. 15, May 1963. 

U.S. Navy Medical Neuropsychiatrlc Research Unit, San Diego, Calif . 

1. Studies of Classical Heart Rate Conditioning in the Rat: 
Report No. 63-3, January 1963. 

2. Photic Activation and Photoconvulsive Responses in a Nonepileptic 
Subject: MR 005. 12-2304 Subtask 1 Report No. 62-8, July 1963. 

3. Response Specificity for Difference Scores and Autonomic Lability 
Scores: Report No. 63-12, August 1963. 

4. Emotional Symptoms in Extremely Isolated Groups: MR 005. 12-2004 
Subtask 1, October 1963. 

5. Measurement of Group Effectiveness in Natural Isolated Groups: 
Report No. 63-16, October 1963. 

6. Some Attributes of Spontaneous Autonomic Activity: MR 005. 12-2304 
Subtask 1 Report No. 62-19, 1963. 

7. A Study of the Validity of Mail Questionnaire Data: MR 005. 12-2004 
Subtask 1 Report No. 63-7, 1963. 



22 Medical News Letter, Vol. 43, No. 4 




DEMTAL li kW^ II SECTIOIM 



Interaction Of Human Serum Proteins With 
Local Anesthetic Agents 

Vincent J. Sawinski and Gustav W. Rapp, Departn^ents of Biochennistry, 
Physiology and Pharmacology, Dental School, Loyola University, Chicago, 
Illinois. Jour, of Dental Res. 42(6): 1429-1438, November-December 1963. 

The property of serum proteins, especially albumin, to bind certain positively 
charged ions (cations), among which may be included local anesthetic agents, 
has been studied by Sawinski and Rapp. The clinical significance of this study 
is not clear since the data did not show that these serum proteins are a priori 
necessary for either the anesthetic efficiency or successful elinnination of 
these agents from the body. 

Four local anesthetics were studied, procaine, butethamine, lidocaine, 
and mepivacaine (Novocaine, Monocaine, Xylocaine and Carbocaine). Each 
anesthetic was made up in concentration from 0. 2 to 0. 002% in M/15 phosphate 
buffer pH 7. 0. Human serum albumin (. 2% in M/15 phosphate at pH 7. 0) was 
then dialyzed against these local anesthetic solutions for four days or until the 
system came to equilibrium. The remaining concentration of anesthetic agent 
in the dialyzing solution outside the bag was measured and the decrease in 
molarity was taken as an indicati'on of the binding affinity of albumin in that 
particular system. The authors postulated that the human albumin molecule 
has two binding sites for cationic local anesthetics. Novocaine and Monocaine 
showed affinity constants 2 orders of magnitude lower than Xylocaine and Car- 
bocaine. This difference was apparently due to internal ester (procaine and 
butethamine) or annide (lidocaine and carbocaine) linkages. It is tempting to 
speculate that the apparent greater affinity of Xylocaine and Carbocaine for 
serum albunnin constitutes a physiologic disadvantage to the extent that these 
anesthetics might be less readily detoxified in the circulating plasma. 
(Submitted by CDR K. C. Hoerman, DC, USN, N. M, R.I. , Bethesda, Md. ) 

JjC ?pC r^ iP SfJ^ 5p: 

A Portable Dental Sterilizing Cylinder 

CDR L. W. Wachtel, MSC, USN and CAPT L. M. Armstrong, DC, USN, 
Naval Dental School, NNMC, Bethesda, Maryland. Research Report, 
28 June 1963. 



Medical News Letter, Vol. 43, No. 4 23 

The moat reliable medium recommended for the sterilization of dental instru- 
ments is superheated steam. However, superheated steam cannot be employed 
under emergency field conditions that do not permit the use of conventional 
equipment such as autoclaves; nor can it be used to sterilize dental instruments 
that will corrode if placed in water. Currently, no accepted method of steriliz- 
ing dental instruments will satisfy emergency conditions and, at the same time, 
safeguard corrosion-susceptible instruments. 

Chemical sterilization with ethylene oxide gas has been shown to be less 
dapnaging to many types of materials than any known method of sterilization, 
but the gas is extremely flannmable and must be mixed with an inert gas such 
as carbon dioxide or dichlorodifluoromethane (Freon-12*), When it is mixed 
with 90 per cent carbon dioxide or 88 per cent Freon, ethylene oxide gas is 
safe and will not burn. The advantage of the Freon mixture is that it may be 
packaged in small containers at low pressures of 3 to 5 atmospheres. 

Temperature is an important factor in sterilization with ethylene oxide. 
At room temperature an exposure time of as long as 16 hours may be reqiiired, 
but the time can be reduced by increasing the temperature. Phillips reported 
a reduction in sterilization time by a factor of 2. 74 for each 10° C. rise in 
temperature between the range of 5° and 37° C. Sterilizers utilizing ethylene 
oxide at elevated temperatures are available commercially, but the smallest 
units on the market are expensive and not easy to employ under emergency 
conditions. 

The purpose of our study was to fabricate a device that could be used 
to sterilize dental instruments rapidly, that could be employed under emer- 
gency field conditions, and that would protect the instruments being sterilized. 

Materials And Methods 



A sterilizer was made from an aluminum tube approximately 9 inches 
in length and having an outside diameter of I 3/4 inches and an inside diameter 
of 1 1/2 inches. The tube was sealed at both ends by aluminum threaded plugs 
3/4-inch thick. These plugs were fitted with plastic gaskets made from sili- 
cone rubber (Silastic RTV 502**). Each plug was vented by means of a small 
brass petcock. When sealed, the cylinder was found to be capable of with- 
standing at least 7 p. s. i. internal pressure without leaking. 

To operate the sterilizer, one of the end plugs was removed, and clean, 
dry instruments were inserted in the cylinder. After the plug had been re- 
placed and tightened sufficiently to prevent leaking, an ethylene oxide contain- 
er was connected to one of the opened petcocks, and gas was flushed through 
the cylinder for about 10 seconds to ensure replacement of the air by the ster- 
ilizing gas. Both petcocks were then closed tightly, and the cylinder was 
immersed in boiling water for 1 hour. The ethylene oxide gas mixture selected 

*Freon is the trademark for fluorinated chlorohydrocarbons produced by 
E. I. Du Pont de Nemours & Co. , Inc. , Wilmington, Del. 
* *The Dow Corning Corp. , Midland, Mich. 



24 Medical News Letter, Vol, 43, No. 4 

for this study was an experimental mixture containing 19 per cent ethylene 
oxide and 81 per cent Freon-12. 

To determine the effect of the procedure on dental instruments likely 
to corrode, several tungsten carbide (high carbon) steel burs, carbide steel 
chisels, and scalpel blades were put through the sterilizing system 12 times. 

The sterilizing effectiveness of the procedure was tested using cor- 
rosion resistant stainless steel explorers, carvers, and knives that had been 
contanninated by swabbing with a suspension of Bacillus subtilis (globigii) spores. 
These contaminated instruments, along with bacterial spore strips (Spordex*), 
were placed in the sterilizing cylinder, subjected to the sterilizing system, and 
then transferred to test tubes containing beefheart infusion broth as a culture 
medium. After incubation at 37° C, for 2 days, the broth contained in each tube 
was examined to deternnine whether there had been any bacterial growth. 

Results 



No visible corrosion or alteration of the steel burs and instruments 
was noted after 12 sterilizing procedures. 

Contaminated instruments and spore strips were successfully sterilized 
by the procedure employed, as evidenced by the absence of bacterial growth 
after the instruments had been placed in broth and incubation at 37° C. had 
proceeded for 2 days. 

Procedures Preceding The Prosthodontic Prescription 

M. M. DeVan, D. D. S. Univ. of Pa., The Graduate School of Medicine, 
Philadelphia, Pa. Jour. Pros. Den. 13(6): 1006-1010, November, December 

1963. 

Dr. DeVan diacuasea diagnosis in relation to complete dentures fronn the stand- 
point that this is one of the most important parts of the prosthodontic service. 
Failure to make an adequate diagnosis cauaea a high percentage of denture 
failures. He presents seven steps in the diagnostic aervice. By following these, 
patients would be treated more satisfactorily than if the diagnosis consists of 
the observation that the teeth are nnisaing and that the residual ridges are large 
or amall on large or small dental arches. 

The steps presented and diacussed are: (1) roentgenograms of the re- 
sidual bone; (2) alginate (irreversible hydrocolloid) impressions; (3) diagnostic 
denture models which incorporate the maximum vertical dimension permitted 
by the musculature; (4) the mounting on an articulator of the denture models 
in centric relation; (5) tranaillunnination of the sinuses and examination of the 



Medical News Letter, Vol. 43, No. 4 25 

patient's lips, cheeks, throat, and tongue; (6) recordings of the denture his- 
tory; and (7) the prescription and presentation of the findings to the patient. 

:{: 4: :^ >!« ^ ii; 

Powde red Gold As A Restorative Material 

Melvin R. Lund, D.M. D. , M. S. , and Lloyd Baum, D. M. D. , M. S. 
Loma Linda University, School of Dentistry, Loma Linda, California. 
Jour. Pros. Den. 13(6) : 1151-1159, November, December 1963. 

Doctors Lund and Baum introduce a new form of cohesive gold for condensed 
restorations. The powdered gold is wrapped in cohesive foil and the technique 
of condensation is simplified. In many cases, hand pressure alone is sufficient 
to yield a hardness which compares favorably to conventional foil restorations. 
Approximately 1500 restorations of powdered gold are under observation and, 
up to publication of this article, the enduring qualities appear favorable. 

Personnel and Professional Notes 

Navy Opens Dental Research Facility At San Diego . On 16 January 1964, the 
Administrative Command of the Naval Training Center, San Diego, opened a 
newly installed clinical dental research facility at the Naval Electronics Lab- 
oratory, San Diego, California. The new facility is an expansion of the guest 
privileges first granted in 1952 to dental officers of the Administrative Com- 
mand to make available the extensive scientific equipment and consultative 
services of the Naval Electronics Laboratory for exploring dental problems. 
Since that date, dental studies have been conducted at the Naval Electronics 
Laboratory for exploring dental problems. Since that date, dental studies have 
been conducted at the Naval Electronics Laboratory by Captains A. R, Frechette, 
A. K. Kaires, N. W. Rupp, and R. R. Perkins, of the US Naval Dental Corps. 

The last-named investigator developed a prototype instrument capable 
of recording basic electric characteristics of human teeth. To determine which 
conductivity parameters can be correlated with the susceptibility of an individ- 
ual tooth to disease, it became necessary to provide a clinical facility at the 
Naval Electronics Laboratory, to bring relatively large numbers of patients to 
the extensive electronic equipment. To meet this requirement, the NEL pro- 
vided space for construction of the new laboratory, dark room, dental operating 
roonn, and office. 

Participating in the ceremonies were: RADM F. M. Kyes, DC, USN, 
Assistant Chief of the Bureau of Medicine and Surgery for Dentistry and Chief 
of the Dental Division; CAPT L. W. Rogers, USN, Commanding Officer of the 
Naval Training Center's Administrative Command; CAPT H. C. Mason, USN, 
the Naval Electronics Laboratory's Commanding Officer and Director; and 



26 Medical News Letter, Vol. 43, No. 4 

CAPT B. H. Faubion, DC, USN, District Dental Officer for the ELEVENTH 
Naval District, and Dental Officer, US Naval Training Center, San Diego. 

Fluoridation Wins In New York City . The long-standing preventive dentistry 
program, sponsored by the dental profession, took a giant step forward with 
the passage of fluoridation by the New York City Council and Board of Estimate. 
If the recent findings of a study in New Britain, Connecticut are substantiated, 
older citizens will benefit along with the younger people who will have a 60 
percent reduction in the incidence of dental caries. 

This study in New Britain by Dr. Paul D. Rosahn reports that there is 
"suggestive evidence still linder review, and not yet fully authenticated, that 
a fluoridated water supply may possibly be one of several variables which have 
been responsible for the prolongation of life, or the postponement of death. " 
He said that the percentage of all deaths for those people under the age of 20 
decreased from 21 to 17 percent by comparing the before fluoridation (1951) 
period autopsies to those in the period after fluoridation. 

Dr. Rosahn' s study involved 3, 296 human autopsies from 1937 to 1962. 
He based his statements on the fact that his study showed there had been no 
significant changes in death rates due to kidney, cardiovascular, liver, and 
cancer diseases. 

Navy Presentations At Chicago Dental Society Midwinter Meeting . Four dental 
officers from the Naval Training Center, Great Lakes, Illinois, presented 
Table Clinics at the 99th Midwinter Meeting of the Chicago Dental Society, 
February 2 to 5, 1964, at the Conrad Hilton Hotel, Chicago, Illinois. Captain 
William E. Ludwick, DC, USN, presented "Wearing Rubber Gloves for Oper- 
ative Dentistry. " Captain William I. Gullett, DC, USN, presented "A New 
Design for Occlusal Rests. " Lieutenant Commander Harris J. Keene, and 
Lieutenant Richard J. Grisius, DC, USN» collaborated on "Mass Casualty 
Training for Dentists. " 

Captain Myron G. Turner, DC, USN, is the Dental Officer, Adminis- 
trative Command, USNTC, Great Lakes, Illinois. 

The Second Annual Postgraduate Course In Forensic Dentistry. The Armed 
Forces Institute of Pathology, Washington, D. C. , recently presented the sec- 
ond annual postgraduate course in Forensic Dentistry. The course was di- 
rected by Captain Henry H. Scofield, DC, USN, Chief, Dental and Oral Path- 
ology Division. Major Bruce C. Young, MPC, USA, Chief, Legal Medicine 
Section, Forensic Pathology Branch, and 1/Lt. Philip A. Faix, Jr., USAF, 
MSC, Legal Counsel to the Director served as Associate Course Directors. 

The course was attended by 46 Military and Civilian Dentists, Military 
Investigators, and JAG Corps Officers. Among those in attendance was Dr. 
Gerard J. Casey, Secretary of the Council on Hospital Dental Services of the 
American Dental Association. Guest lecturers included Dr. John J. Salley, 
Dean of the University of Maryland School of Dentistry, Dr. David B. Scott, 
Chief of the Laboratory of Histology and Pathology, National Institute of Dental 



Medical News Letter, Vol. 43, No. 4 27 

Research, Mr. Herbert Lasaiter, Secretary of the Council on Federal Dental 
Services, American Dental Association, and Mr. Harvey Sarner, Secretary 
of the Judicial Council, American Dental Association. The highlights of the 
course included a laboratory session involving the identification of human re- 
mains by means of dental records, and a "Mock Court Trial" depicting the 
role of a dentist as an ordinary or expert witness. 

AFIP LETTER, Armed Forces Institute of 

Pathology, Washington, D. C. 

NOTE: Captain Henry H. Scofield, DC, USN, has been appointed Chief, Den- 
tal and Oral Pathology Division, Armed Forces Institute of Pathology, and 
Registrar, ADA Registry of Oral Pathology. He was previously Head, Oral 
Pathology Division, U. S. Naval Dental School, Bethesda, Maryland. 

Editor 

Captain Alfred L,. Raphael Presents Lecture To Local Dental Group. Captain 
Alfred L. Raphael, DC, USN, Acting Commanding Officer of the U, S. Naval 
Dental Clinic, Guam, M. L , presented a lecture with slides on the treatment 
of disorders of the Temporal -Mandibular Joint at the October 1963 meeting of 
the Guam Dental Society at Anderson Air Force Base. Approximately Thirty- 
five persons were in attendance for the lecture. Captain Raphael is a Diplo- 
mate of the American Board of Periodontology, 

Captain T. J. Pape Presents Lecture To Local Dental Group. Captain Thomas 
J. Pape, DC, USN, an Oral Surgery Resident at the U. S. Naval Hospital, 
Great Lakes, 111., presented a lecture entitled "Complications of the Maxillary 
Sinus" before the Kenosha Dental Society on 12 November 1963 in Kenosha, 
Wisconsin. Captain Joseph F. Link, DC, USN, is Chief of Dental Service at 
the U. S. Naval Hospital, Great Lakes. 

Naval Dental School Sends Twenty-Nine Advanced Dental Technicians To The 
Field. Certificates for successful completion of Advanced Training Courses 
in the Enlisted Schools of the U. S. Naval Dental School were awarded to 
twenty-nine dental technicians at graduation exercises on 13 December in the 
main auditorium. National Naval Medical Center, Bethesda, Maryland. 

"The Role of the Individual in Group Progress Personal Creativity" 

was the theme of an address to the graduates by Captain Nelson W. Rupp, DC, 
USN, Head, Training Section, Professional Branch, Dental Division, Bureau 
of Medicine and Surgery. 

Captain A. R. Frechette, DC, USN, Commanding Officer of the Dental 
School, presented letters of commendation to those students with the highest 
averages in their respective fields of Dental Technology: Dominic G. Zaia, 
DTCA, Advanced Prosthetic; Felix S. McGeary, DTI, Advanced General. 

Felix S. McGeary also received the eighth Thomas Andrew Christensen 
Award in recognition of his loyalty and devotion to duty in the U. S. Navy. 
Established by the Naval Dental School to honor the only Naval Dentalman 



28 



Medical News Letter, Vol. 43, No. 4 



Posthumously presented the Navy Cross for extraordinary heroism, the award 
will be presented, from time to time, to a graduate of an enlisted course of 
instruction who will be chosen on the basis of his service record and service 
reputation. 

Captain Frechette, assisted by Captain R. R. Troxell, DC, USN, Head 
Enlisted Education Department, awarded certificates to nineteen graduates of 
the Advanced General School and ten of the Advanced Prosthetic School. 

Navy Communication Station Holds Open House For Two P hilippine Dental 
Societies. The Dental Department of the U, S. Naval Communication Station, 
San Miguel, Zambales, Philippines hosted an open house for members of the 
Zambales, and Olongapo Dental Societies on 15 December 1963. 

Captain B. D. Gaw, USN, Commanding Officer of the Communication 
Station welcomed honored guests and the members of the two Philippine Dental 
Societies. Captain A. Bartelle, DC, USN and Lieutenant R. P. Jones, DC, 
USN, presented patients to demonstrate treatment technics performed in the 
Dental Department, Presentations included: a full mouth rehabilitation for 
a five year old dependent using cennent-alloy restorations, an endodontia pa- 
tient and a periodontia patient. Lectures were given on Oral Diagnosis and 
Treatment Plajining as practiced at the U. S. Naval Communication Station, 
Preventive Dentistry and Oral Hygiene, and several aspects of the partial 
denture service. 

Newly Standardized Items Available For Issue 



FSN 

L6520-055-1518 
L6520-055-1519 
L6520-082-2673 

L6520-721-6290 

L6520-889-7498 

L6520-889-7499 

L6520-890-1382 
L6520-890-1386 
L6520-955-5275 
L6520-960-2639 

L6520-960-2640 



NOMENCLATURE 

Frame, Dental Laboratory Saw 
Blade, Dental Laboratory Saw 
Mouthpiece, Saliva Ejector, Dental, 
Plastic, Disposable, 500's 
Bur, Dental Excavating, AHP, Tungsten 
Carbide, No. 8, 6s 

Crown Set, Temporary, Dental, CRS 
Posterior Crown Assorted, Set of 36 
Crown Set, Tennporary, Dental, CRS 
Anterior Crown Assorted, Set of 36 
Processing Unit, Dental Resins 
Spreader, Gutta Percha, Dental, No. 3 
Carrier Amalgam, Ivory Type 
Bur, Dental Excavating, Friction Grip 
AHP, Tungsten Carbide, No. 699, 6s 
Bur, Dental Excavating, Friction Grip 
AHP, Tungsten Carbide, No. 700, 6s 



UNIT 


UNIT 


ISSUE 


PRICE 


EA 


1.40 


PG 


1.40 


PG 


15.40 


PG 


2.60 


SE 


7.60 


SE 


7. 50 


EA 


32.50 


EA 


1. 70 


EA 


1. 90 


PG 


2.70 



PG 



2. 60 



Medical News Letter, Vol. 43. No. 4 29 

L6520-973-5079 Evacuator, Oral Cabity, Dental, 110 volt EA 150.00 

60 cycle, AC (For S. S. White Units) 
L,6520-982-9622 Articulator, Dental Plain Line EA 6,07 

L6520-982-9892 Wheel Abrasive, Alum Oxide, Sq, Edge PG 4.30 

11/2 X 0.033, 100s 
L6520-966-3729 Furnace, Dental Lab, Electric Muffle EA 231.00 

Type Lrg. >with Pyronneter Automatic 

Temperature Control, llOV 60 Cycle AC 

:}: ^ :{( >|e :{: :[: 

AVIATION MEDICINE DIVISION 




Flight Physiology Notes 

From: Aviation Physiology Training Unit, U. S. Naval Air Station, 
North Island. 

J. A. M. 



(Keeping "Out Of" Type) 

Aircraft accident responsibility undergoes cyclic changes which can not al- 
ways be clearly defined. In the good old days it was the fragile aircraft struc- 
ture that contributed significantly to accidents and prevention was accomplished 
by flying only iinder ideal conditions. As demands for flights under more ad- 
verse conditions increased it was necessary to strengthen supports, improve 
fabrics and power plant reliability. In general, the emphasis was upon making 
the aircraft safe. As engineers became convinced that their contributions 
were adequate, a new term "pilot error" enjoyed, (still does), wide acceptance 
as a "cause" of accidents. It is unfortunate because little search was done 
beyond this point until attention was directed to the internal environment of 
the cockpit and the interface between the aircraft and pilot. This awakening 
of the importance of man in this man-machine combination started the era 
of display-control relationships, analysis of eye movements for instrument 
location, what instruments were watched, and for how long, location of con- 
trols, shape of handles, etc. Following along with this, simulators and pro- 
cedural trainers became a dominant part of training and a vocabulary grew 
along with these developments to include such things as learning, set and 



30 Medical News Letter, Vol. 43, No. 4 

transfer, fixation, purpose drive, etc. , and the field of human engineering 
and human factors blossomed. 

It was soon discovered that learning did not undergo transition as rapid- 
ly as man changed aircraft types. To further complicate matters, advances in 
aircraft design continued to increase the overall performance; now considera- 
tion also had to be given to man's physiological needs in order to keep the man- 
machine relationships compatible. Physical standards had to be reviewed and 
medical selections improved. "G" tolerance, spatial disorientation, hypoxia, 

hyperventilation, vital capacity and cardiovascular responses all had to 

be evaluated as to their contributions to pilot error. Trying to keep man as 
error-free as possible in this man-machine combination is a real challenge. 
Many people in the various physical science disciplines have strongly 
recommended that man be dropped from the system and replaced by the now 
highly sophisticated computer systems. They argue that the support systems, 
(G suits, pressure suits, O2 equipment, poopy suits, hard hats, etc. }, intro- 
duce a delicate balance wherein the support system, per se, now produces its 
own potential source of accident, as a result of delayed reaction time, limited 
mobility, fatigue, claustrophobia and psychic trauma. Fortunately the space 
progran: not only re-established the vital role of manin the man-machine 
relationship, but demonstrated the fact that man could adapt Eind perform ef- 
fectively and efficiently even though encumbered with all necessary support 
protective equipment. It is interesting to note that man with properly designed 
support equipment can better withstand flight stress than can the computer and 
mechanical systems. 

Investigation as to the cause of accidents continued and led back to 
displays with questions of "what" to display and "why" rather than "where" 
and "how". Today the pilot has intergrated displays, power boosted systems, 
automatic ejection system, pressure suits, automatic pilot and a host of other 
gadgets, electronic and otherwise, which are designed to help eliminate error 
and to provide safety and comfort. All of these apparently do their jobs well. 
But the pilot still has accidents, undoubtedly due to "pilot error /human factors". 
Accidents do occur in "perfect flying weather" and under ideal flying conditions 
of both pilot and aircraft. Is it possible that man can be too protected and too 
comfortable? It is perhaps time that we give some thought to the potential 
hazard of stimulus poor environments and such things as pre-occupation, be- 
haviors, micro-sleep, and fatigue. In order for man to remain alert there 
must be a constant change in his external and/or stimulus environment. Stim- 
uli which come either infrequently or with steady uniformity result in decreased 
attention. There are conditions in which man is oblivious of sensory inputs 
even though they objectively exist. Anticipatory behavior is one of these con- 
ditions, and accidents will occur when the estimate or anticipation is faulty, 
when things one expects to hold constant vary or when the pilot fails to take a 
variable into consideration. This is particularly true when fatigued, when the 
task becomes too routine, or things are "too good'^, the anticipated "cut" in 
carrier lajidings, the "almost home" or "got it made", the premature relaxing 
in the groove of a familiar pattern, the sudden appearance of another aircraft 



Medical News Letter, Vol. 43, No. 4 31 

or other variables which must have been available to the pilot but he did not 
actively attend to it. He had set up a pattern, anticipated his procedure, and 
"tuned out" his personal input channels. It is not uncommon to become so 
preoccupied with instruments or other tasks that you become oblivious to your 
surroundings. In addition, how often do you find yourself at a loss to accoiint 
for periods of time, not day dreaming, but actual blank periods. This so called 
micro-sleep is apparently a complete shutting down of the brain for short rest 
periods, (10 milliseconds to 3 seconds), which become more frequent and of 
longer duration, the longer you are awake, the more you are fatigued, and the 
less stimulating is the environment. 

Odd as it may seem there will be tiroes when an accident would not 
have occurred if the overall conditions had been marginal rather than ideal. 
These accidents that occur under ideal conditions always have the element of 
"I don't see how it could have happened", they are literally "senseless" in that 
the humans sensory systems have been monentarily closed. 

Perhaps the next approach will be in finding deliberate ways of degrad- 
ing the "too perfect" situation. Several very astute psychologists have even 
proposed "random electrical shocks to an appropriate part of the pilots anatomy". 
The Navy Safety Center recently enacted a new technique for analyzing acci- 
dents using the verbal labels of Judgement, Attention, and Memory - The J. A. M. 
Factors. It is hoped that such analysis can lead to improvements of the afore- 
mentioned situations and thereby reduce accidents. Let us hope that these new 
J. A.M. factors do not become another, slightly amplified, substitute for "pilot 
error". 

Hazards Of' Dusk 

The difficulties pilots experience on landing at dusk or when the sun 
is 5° above the horizon to 18° below the horizon, are perhaps not widely real- 
ized. A penetration from ZO, 000 ft. and above to a landing, all of which occurs 
from 5-10 minutes later, maneuvers the pilot from daylight to dim twilight or 
almost night conditions faster than dark adaptations can take place. 

At sunset there is a relatively bright sky, a visible sun and a dark 
earth. Clouds may be bright and may be a source of illumination for the earth; 
however, depending on their location, they may be dark and may limit light 
from the sky to the earth. 

Atmospheric haze is particularly significant at this time of day. The 
rising of dust by nature and by man, and the lifting of water from the land or 
by the sea during th_e heat of the day tend to produce maximum haze at dusk. 
This haze lies as a veil over the ground/ sea. It is illuminated by skyshine 
and sunshine; when viewed from above it can drastically obscure the earth be- 
neath. Visibility through a "standard ordinary clear atmosphere" might be 
considered as 20 miles. At dusk, due to atmospheric haze, visibility is re- 
duced to a fraction of this. 

Ground brightness levels depend on two sources of light. Skyshine may 
be the principal source and the second source is sunshine; but, at this time 



32 Medical News Letter, Vol. 43, No. 4 

of day, ground shadows result in the darkening of vast areas. The tangential 
direction of the sun's rays outlines projections and contours which are mis- 
leading to the uninitiated and which must be interpreted with care, even by 
the experienced. The rapid visual shift from altitude conditions to dusk land- 
ing conditions re suits in an earth depopulated of all but its most prominent ob- 
jects, with almost a complete loss of any true color. 

Because there is a decrease in the visible objects below, although ob- 
jects on the horizon may remain, the pilot's appreciation of the space below him 
will be changed and may appear smaller than it is, which in-turn gives it a new 
more pronounced contour. 

Added to all of this is a pronounced loss of visual acuity and of the vis- 
ual field due to the decreased light levels that result during the descent at 
dusk. This in-turn causes a tendency toward space or night near-sightedness 
which may be significant enough to blur objects on the ground. 

The pilot who makes a dusk descent and landing is faced with the facts 
that the eyes cannot dark adapt rapidly enough, visual field acuity and visual 
field size are decreased, colors are untrue, objects are distorted or nsissing 
and time and distance are working against him. He therefore should develop 
the wise habit of relying heavily on his instruments. Cockpit lights set for 
night vision will be too dim; standard daylight illumination turned down slightly 
would be in order. The importance and value of oxygen under these conditions 
should be remembered. The pilot should be prepared to accept the spatial 
clues of night, which are supplied by the airport lights; added detail may be 
perceived by turning on his own lights. 

Hegardless of how well one may understand these phenomena, you can 
not fully appreciate the degree to which your unassisted vision is decreased, or 
the extent to which it may present erroneous information. Instruments, land- 
ing lights, and airfield lights may be the most accurate guides and should be 
utilized generously. 

fj! .;;: 5{< :}! :^ ^ 

Leadership Concept:- -Hard Versus Soft Managem ent 

The difference between the good leader, manager, or supervisor and the run- 
of-the-mill one is that the good leader makes things happen while the other 
allows things to happen. This is frequently referred to as the difference be- 
tween the traditional, military or "hard" management and "soft" management. 
In "Hard" management, the leader knows what he wants to have happen and 
what needs to be done to accomplish this mission. In "soft" management the 
leader backs off from responsibility and merely allows things to happen. How- 
ever, there is only one kind of leadership — that conduct which induces fol- 
lowership andaids in accomplishment of mission. It has to be adapted to the 
situation. On occasion it may be driving — a kick in the seat; other times it 
maybe pulling — inquiring into and tapping a person's mental resources. 
Whichever it is, it requires knowledge of human behavior to promote outstand- 
ing performance. 



Medical News Letter, Vol. 43, No. 4 33 

When Business is Slow DA NANG Doctors Go 

Article in 20 Dec 1963 issue of The Rotor Blade - Special Services 
Newsletter of the MCAF FUTEMA, MAG-16 1st MAW. 

DA NANG, Republic of Vietnam -- When chores at the U. S. Marine Medical 
Dispensary here aren't pressing. Navy doctors and corpsmen attached to the 
U. S. Marine unit regularly hop in a jeep or helicopter to find ones that are. 
A five-minute jeep ride takes them to a Vietnamese Army camp's de- 
pendents school where they push aside desks and chairs in the kindergarten 
classroom and hold clinics twice a week. 

And one of the doctors, Lt. Ronald F. Swanger, Medical Corps, USN, 
pays a call to a thatch- roof dispensary at Nam Dong, a remote village in north- 
central Vietnam, when there's a Marine chopper heading that way. 

Started last summer by the late Lt. Bruce Farrell, the program of 
medical aid to the Vietnamese has matured into one of the more valuable 
people-to-people projects in Vietnam's I Corps sector of counter-insurgency 
operations. Doctor Swanger and Lt. Thomas K. Ciesla, Medical Corps, USNR, 
took over the program in October, (1963). 

The doctors and their dispensary's six corpsmen alternate on the Tues- 
day and Thursday morning visits to the school. They're helped by two Viet- 
namese nurses, Nguyet and Minh Phuong, and an, interpreter they call "Loc. " 

Swanger also takes a corpsman along with him to Nam Dong. They 
meet SFC Adolph G. Wilson, U. S. Army Special Forces medic at nearby 
Tarau outpost, and with an interpreter and two nurses, drive to the village. 
Progress with modern medicine among the Vietnamese has its prob- 
lems. Centuries-old methods of the "witch doctor" are deep-seated in the 
beliefs of the Vietnamese adults. Some will see the "strange" doctor only as 
a last resort, "By then, it's generally too late," Swanger says. 

Even when the patience and perseverance of the Marine doctors appear 
to have offset these beliefs, they often discover their patients still seeing the 
"witch doctor" and using his home "remedies. " "Guess they figure if they get 
both kinds of treatment, they'll be that much better off, " muses Sgt. Wilson 
about his experiences at Nam Dong. 

Another headache is getting patients to follow treatments. Many have 
yet to gain confidence in modern medicine, either from the Americans or from 
reputable Vietnamese doctors. "If they don't get relief immediately, they 
atop taking the prescription, " Swanger explains, "On the other hand, they stop 
if they do get relief, and often the disease hasn't been completely wiped out. " 

Ciesla and Swanger fight unfaithful treatment and save medicine that 
might otherwise be wasted by issuing only a day or two's supply. A patient 
must return for further doses. They give injections as much as possible "so 
we're positive the treatment is doing the most good, " Ciesla adds. 

"These people respond tremendously to antibiotics, " reports Doctor 
Swanger. "The disease germs of many of the sick haven't been subjected to 
antibiotics before and so haven't built up the slightest defense against them. " 



34 Medical News Letter, Vol, 43, No. 4 

Typical of what Americans encounter at clinics was Swanger's most 
recent at Nam Dong in late November. HM3 John W. Clark, Jr. , the Doctor, 
and Sgt. Wilson worked four hours to treat 125 patients for tuberculosis, hook 
worm, dermatitis, stomach infections, vitamin deficiencies, and assorted 
boils and eye troubles. 

Clark and Wilson used their dental training to pull a few teeth. 
There was an infant girl with cellulitis, a skin infection. A "witch 
doctor's" potion was smeared over her head and arms. Swanger gave the 
child a shot of penicillin. He. t6ld the mother to wash the girl and bring her 
to Tarau outpost's dispensary that afternoon for a few days treatment. The 
nnother never came. 

There was an eight-year-old girl suffering from a form of psychosomat- 
ic shock since the death of her mother 20 days before. The girl couldn't walk. 
But she was fortunate enough to be under care. One of the most encouraging 
signs of progress at Nam Dong lies in villagers' plans to build a new dispen- 
sary. Twice the size of the present dirt-floor hut, it will have a waiting room, 
pharmacy, emergency and treatment rooms, a doctor's office, an eight-bed 
ward- -wooden floors. 

"There's a distinct difference between the people at Nam Dong and the 
Vietnamese dependents at the school, " Swanger reports. "In the village, there 
were only the home remedies of 'witch doctors' until Special Forces came. 
Also, their standards of health and sanitation are significantly lower than those 
of the Da Nang military people. We can find the same diseases in both groups 
but those of the mountain people show a sharp contrast in symtoms and severity 
over their city-dwelling counterparts. " 

Besides Clark, the U. S, Marine Corps Dispensary's roster of corpsmen 
involved in clinics includes Chief Hospitalman Cecil R, Hasha; John B. Stani- 
street and Anthony M. Vega, both hospitalmen second class; HM3 Richard E. 
Baldwin, and Hospitalman William V. Baltzer. 

* * * si: !(; :^ 

What is an Aviation Physiologist ? 

By Lieut. Martin Passaglia, MSC, USN, Naval Medical Research Insti- 
tute, NNMC, Bethesda, Md. 

An Aviation Physiologist is a Naval Officer first and foremost, with all of the 
duties and responsibilities inherent to this honorable profession. He is a con- 
scientious, loyal and faithful representative of the naval service, commanding 
respect from his subordinates and admiration from his superiors for his 
knowledge, ability, devotion to duty, dedication and motivation to give himself 
to the Navy unswervingly at all times. He must serve many masters who de- ' 

mand his services and abilities at their convenience: his country, the Navy, 
his crew, as well as. his civilian contemporaries whose freedom he has sworn 
to uphold. All of these masters require obedience, incontestable allegiance 



Medical News Letter, Vol. 43, No. 4 35 

and a devotion to duty which on. occasion must surpass his devotion to his 
family and friends. In essence, he is a servant with complete obeisance to 
the needs of his country and of the Navy. He must be imbued with this spirit 
throughout his entire career and these thoughts should control all of his ac- 
tions and relations with those who would desire his services. 

The Aviation Physiologist moreover is a representative of the Medical 
Service Corps, a specialist in one of the more practical aspects of aviation 
medicine with knowledge, competence and extensive training in those problems 
which fall under his aegis. As a member of the Medical Service Corps his 
sole function is to serve to the very limits of his capacity the needs of the Corps 
whose raison d'etre is service to the Fleet and the Medical Corps. The Avia- 
tion Physiologist is a supplement to the Flight Surgeon who must necessarily 
call upon the specialist for definitive answers to very specific queries into 
matters under the jurisdiction of the physiologist. The Aviation Physiologist 
should be aware constantly of his place and function in the Medical Department 
as an assistant to the Flight Surgeons. Accordingly, his knowledge should re- 
flect his academic background, his training, his abilities and his motivation 
to succeed in his chosen field of endeavor. Toachieve some measure of success 
in this field, the aviation physiologist should be erudite, articulate before all 
groups, and not without some ability to manipulate the various instruments 
and tools which are at his disposal for training and instruction. Above all he 
should be capable of imparting his knowledge to his assistants and to the stud- 
ents who come to him for instruction and qualification. Knowledge, enthusiasm, 
and an unselfish devotion to duty should be the creed of the Aviation Physiolo- 
gist. 

Throughout his career the aviation physiologist should retain an aware- 
ness of his dual-nature as a Naval Officer/ Physiologist and should strive diligent- 
ly to succeed in both as a good Naval Officer, his primary responsibility, and 
as an accomplished Aviation Physiologist in the Medical Service Corps. These 
two natures cannot and should not be separated and throughout his career re- 
gardless of his duty, the aviation physiologist must labor with increased devo- 
tion and efficacy to retain his unique, position. To become only academic and 
scholarly many jeopardize the primary stature of the physiologist as a Naval 
Officer with a resultant detrimental effect on the structure of the Medical 
Service Corps. The true aviation physiologist is a bridge spanning the area 
between specialization in aviation medicine and the role of a functional, energetic 
Naval Officer. Conscientious application of sound and well established prin- 
ciples of naval leadership, customs, traditions, and disciplines will assist 
the aviation physiologist to maintain his dual-role and successfully accomplish 
his mission in the Navy and service for his country. 



:{!***** 



36 Medical News Letter, Vol. 43, No. 4 

Immersion Hypothermia 

By Captain David Minard, MC, USN (Ret), USN Medical News Letter, 
29(1): 35-38, Jan. 4, 1957 (Then Cdr. MC, USN). 

Acute general hypothermia resulting frona immersion in sea water at temper- 
atures below 68° F. (20° C. ) is a serious hazard to survivors of ship or air- 
craft disasters at sea. The human body when immersed in cold water loses 
heat from two to four times faster than it does when in air at the sanne tem- 
perature. Therefore, unless the ocean temperature is 70° F. (21° C. ) or 
above, survival following immersion is limited to a few hours in moderately 
cold water (50° F. - 68° F. ) and may be less than half an hour in the frigid 
seas of the polar regions where water temperatures of from 32° F, (-2° C. ) 
are common. For example, wartime experience showed that in water at 40° F. 
(4. 5° C. ) only 50% of the men survived longer than 1 hour. The degree of cold 
and the njean survival time bear a hyperbolic relationship such that the prod- 
uct of the two is roughly constant. This does not imply, however, that sur- 
vival time can be predicted with certainty from water temperature alone. On 
the contrary, individuaUactors often determine whether a victim of immersion 
will survive a longer or shorter time than that predicted. Some of the more 
important variables determining survival time are: the amount and kind of 
clothing worn, the thickness and distribution of the insulating layer of sub- 
cutaneous fat, the ratio of body surface to body volume, the extent and duration 
of the increased heat production resulting from shivering or swimming activity, 
and the will to survive. 

On acute exposure to cold, man like other homeotherms, possesses 
two important protective mechanisms to safeguard the constancy of his central 
or "core" temperature: first, peripheral vasoconst riction which shunts warm 
blood away from the body surface, thereby reducing heat loss, and second, 
shivering, an involvmtary skeletal motor activity which can increase metabolic 
heat production up to five times the basal level. Diverting blood away from 
the body periphery increases the temperature gradient from core to surface 
and reduces the temperature gradient from the body surface to the cold water 
environment. 

If heat loss is thereby brought into line with the increased heat produc- 
tion, thermal balance is re-established and core temperature is stabilized. 
This situation exists at water temperatures of 68° F. (20° C, ) and above. At 
lower water temperatures, the rate of heat loss exceeds heat production des- 
pite vigorous shivering, and core temperature begins to fall. Shivering and 
also consciousness are progressively depressed as deep body temperature 
falls below 95 F. (35° C. ). From then on, hypothermia proceeds unchecked. 
Lethal levels of body temperature are reached when the net heat loss from 
the body (calories lost minus calories produced) is in the range of 650 to 800 
kilocalories (Kcal. ). A net loss of 800 Kcal. in a 70-kilogram man will result 
in a rectal temperature of 77° F. (25° C. ). Although survival has been re- 
ported in cases of accidental hypothermia with rectal temperatures lower 
than this, such reports are rare. 



Medical News Letter, Vol. 43, No. 4 37 

Death in hypothermia results from cardiac arrest or ventricular fib- 
rillation. Restoring normal cardiac rhythm by electrical and manual means 
is now a common practice when cardiac arrhythmia or arrest occur in inten- 
tional hypothermia employed in cardiac surgery. These methods, however, 
are not of practical value to medical officers applying treatment to survivors 

at sea, * 

The key element in the emergency treatment of immersion hypothermia 

is immediate and rapid rewarming by immersing the victim in a tub bath 
maintained at from 110° to 120° F. (43° - 49° C ). Second best to a hot bath 
is a steaming shower. Hot liquids and brandy by mouth are useful adjuvants, 
but are not in any sense a substitute for external heat. 

The aim of rapid rewarming is to restore body heat without risking 
the danger of "paradoxical cooling, " a phenomenon observed by James Currie 
in human experiments on hypothermia performed over 150 years ago and con- 
firmed by others many times since. The term denotes a sharp further drop 
in deep body temperature which occurs after the victim has been removed 
from the cold water. In this phase, collapse and death are not infrequent, a 
tragic sequel to what first appeared to be a timely rescue. The explanation 
is as follows: During immersion, the surface tissues often referred to as 
the body "shell" are relatively bloodless and reach a temperature only a few 
degrees above that of the water. Return of the victim to a warmer air environ- 
ment induces relaxation of the skin vessels. As warm blood from the core 
perfuses the intensely chilled tissues of the body shell, blood temperature 
approaches that of the tissues. The cold venous blood upon returning centrally 
causes the further fall in deep temperature that was noted by Currie. 

Immersing the victim in a hot water bath prevents this occurrence by 
establishing a steep temperature gradient from outside inward, thus simul- 
taneously heating the surface tissues and preventing heat loss from the per- 
fusing blood. Under these conditions, core temperature begins to rise 
rapidly and within 15 to 20 minutes has risen to 96° F. or higher with complete 
restoration of function and comfort. Recovery is usually complete, although 
mild degrees of local injury of the immersion-foot type have been described. 
Victims of prolonged exposure to mild cold experience chronic rather 
than acute hypothermia. Because there may be additional physiologic dis- 
turbances, such as dehydration and decreased plasma volume, the treatment 
differs from that described for acute hypothermia. Slow rewarming with 
restoration of the depleted volume of circulating blood has been recommended 
as the safer procedure. Chronic hypothermia of this type is not usual in 
immersion and is far more common in accidental cold exposure on land. 

Two items of survival equipment designed to prevent immersion hypo- 
thermia in survivors of ship or plane disasters at sea are, first, the immer- 
sion suit, and second, the inflatable covered life boat. Immersion suits have 
been designed for aviators flying over cold areas of the ocean. When worn 
over dry flight clothing, this permits survival in water at 32° F. (0 C. ) for 
a period of 4 hours and possibly longer. A suitable immersion suit for ship- 
board personnel has not yet been designed. Conditions aboard ship are vastly 



38 Medical News Letter, Vol. 43, No. 4 

different from those aboard^a plane. Impermeable clothing cannot be worn 
continuously below decks or by deckhands doing heavy work in cold weather, 
because evaporation of body moisture is prevented and body heating results. 
An immersion svdt which can be quickly donned before abandoning ship is an 
alternative solution, but further improvements in the design of such clothing 
are needed. 

The second major item of survival equipment in cold waters is the 
inflatable covered lifeboat. In 1951, at Argentia Bay in Newfoundland, ten 
Navy volunteers wearing regulation clothing jumped from the deck of a ship 
into water at 37° F. (2-1/2 C. ), swam to an inflated covered lifeboat, climbed 
aboard, and remained 5 days on survival rations without evidence of serious 
chilling. This equipment is now replacing outmoded life floats and life rafts 
which fail to prevent immersion and its consequences. A technique for the 
direct transfer of shipboard personnel to lifeboats without an intermediate 
sojourn in icy water is urgently needed. 

Medical officers treating survivors can contribute to the sparse know- 
ledge of immersion hypothermia by noting with care water temperature at the 
time and place of rescue, the rectal temperature of the survivor, the duration 
of exposure, and pertinent details regarding clothing and body habitus. 

* {It is to be noted that both external cardiac massage and mouth-to-mouth 
artificial respiration (resuscitation) were developed and accepted as life-sav- 
ing procedures since Doctor Minard's article was written in 1957; under the 
conditions given they should be given a faithful trial). Editor 




RESERVE ^^^=' SECTION 



Erratum Notice Re: Salary and Rank of Naval Interns . The information con- 
tained on page 39 of Vol. 43, No. 1, 3 January 1964 issue of the Navy Medical 
News Letter was partially in error. Paragraph #5 under Naval Internships 
(Continued) is corrected to read: 

"#5. Under present Navy Promotion policies, naval interns are initially 
appointed in the rank of Lieutenant. Interns with dependents receive ap- 
proximately $8, 375 per year; those without dependents receive approxi- 
mately $8, 074 per year. " — Medical Corps Branch, ProfDiv, BuMed. 

>!c sjc 9}: 9ic 9}: 9}: 

Pharmacy and Materia Medica, NavPers 10999-A . This correspondence course 
is now available to applicants. It is outlined on page 19 of this issue of the 
Medical News Letter. 



Medical News Letter, Vol. 43, No. 4 39 

MSC Commander Appointed Executive Director of 
American Occupational Therapy Association 

Commander Frances Helmig, Medical Service Corps, USNR (inactive), has 
accepted appointment as Executive Director of the American Occupational 
Therapy Association, effective 2 January 1964. 

A native of Atlantic City, Miss Helmig received her AB degree from New 
Jersey State Teachers College in 1934 and taught in the Atlantic City Public 
Schools for four years following that date. Her professional education in- 
cludes the certificate of the Philadelphia School of Occupational Therapy and 
a masters degree from the University of Southern California. 

Commander Helmig's professional work experience started as Assist- 
ant Director of the Philadelphia Curative Workshop in 1941. From 1942 to 
1946, she headed the occupational therapy department at the U. S. Naval Hospi- 
tal in Philadelphia and, since that date, has maintained her commission in the 
Naval Reserve. Following the war. Miss Helmig served as Director of the 
Rochester Rehabilitation Center (Rochester, New York) and held consultancies 
with the National Society for Crippled Children and Adults and the Health and 
Welfare Council of Philadelphia. In 1959, she returned to clinical work, as 
Director of Occupational Therapy at the Emily P. Bissell Hospital in Wilming- 
ton, Delaware and since 1961 she has been Chief Occupational Therapist at 
New York's Institute of Physical Medicine and Rehabilitation. 

^ :!i: 3^ :}: ${c :i^ 

Navy Ensign 1915 Medical Program 
(continued) 

Questions And Answers (continued) 

6. While participating in the Senior Medical Student Program, may a 
student work as an extern? 

Yes; however, if such an arrangement is a requirement of the school 
where the student is enrolled any salary or remuneration accepted 
above and beyond the active duty pay of the student must be deposited 
with the Treasurer of the United States, This should not be construed 
to prohibit purely off duty employment if such employment does not 
interfere with performance of duty, i.e. , medical studies^ and does 
not reflect discredit on the naval service. Remuneration received from 
such off duty employment may be retained by the participant. 

7. May Ensign 1915 officers become members of Naval Reserve paid drill- 
ing units? 

No. Membership in a paid drilling unit requires that the individual 



40 



Medical News Letter, Vol. 43, No. 4 



be a "Ready" Reservist, and "Ready" Reservists comprise a group 
which would be called during the early part of a war or national emer- 
gency. Since nnedical students are not eligible for this type of active 
military service until after completion of medical studies and intern- 
ship, they are ineligible to affiliate with paid drilling units of the Naval 
Reserve. Participation in vacation training sponsored by the Navy is 
emphasized as the approved training with pay for the Ensign 1915. 

If a medical student accepts a commission as Ensign 1915 USNR, will 
he receive the 15 gratuitous retirement points for each year of partici- 
pation ? If not, is there any way in which an Ensign 1915 may earn re- 
tirement points while in medical school? 

Yes, providing he earns a minimum of 35 retirement credits during 
each year that he is an Ensign 1915 USNR. Ensigns 1915 may earn re- 
tirement points by participation in the summer training progranns, 
completion of correspondence courses, and attendance at regularly 
scheduled drills of nonpay reserve units. Students enrolled in the 
Senior Medical Student Program earn 1 retirement point for each day 
of active duty served. 

(To be continued) 

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